Review
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Nov 19, 2023; 13(11): 816-830
Published online Nov 19, 2023. doi: 10.5498/wjp.v13.i11.816
Management of acute carbamazepine poisoning: A narrative review
Luan Wang, Yang Wang, Ruo-Ying Zhang, Yao Wang, Wei Liang, Tie-Gang Li
Luan Wang, Ruo-Ying Zhang, Yao Wang, Wei Liang, Tie-Gang Li, Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Yang Wang, Department of General Surgery, The 4th Affiliated Hospital of China Medical University, Shenyang 110032, Liaoning Province, China
Author contributions: Wang L, Wang Y, Zhang RY, Wang Y, Liang W, and Li TG contributed to drafting and editing of the manuscript, and approved the final manuscript.
Supported by Science and Public Welfare Research Fund of Liaoning Province, No. 2022JH4/10100075; and National Nature Science Foundation of China, No. 81772056.
Conflict-of-interest statement: The authors declared that they have no conflicts of interest to this work. We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted and entitled ‘Management of Acute Carbamazepine Poisoning: A Narrative Review’.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tie-Gang Li, MD, PhD, Professor, Department of Emergency Medicine, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Shenyang 110004, Liaoning Province, China. litg@sj-hospital.org
Received: September 5, 2023
Peer-review started: September 5, 2023
First decision: September 14, 2023
Revised: September 23, 2023
Accepted: October 11, 2023
Article in press: October 11, 2023
Published online: November 19, 2023
Abstract

Standard management protocols are lacking and specific antidotes are unavailable for acute carbamazepine (CBZ) poisoning. The objective of this review is to provide currently available information on acute CBZ poisoning, including its management, by describing and summarizing various therapeutic methods for its treatment according to previously published studies. Several treatment methods for CBZ poisoning will be briefly introduced, their advantages and disadvantages will be analyzed and compared, and suggestions for the clinical treatment of CBZ poisoning will be provided. A literature search was performed in various English and Chinese databases. In addition, the reference lists of identified articles were screened for additional relevant studies, including non-indexed reports. Non-peer-reviewed sources were also included. In the present review, 154 articles met the inclusion criteria including case reports, case series, descriptive cohorts, pharmacokinetic studies, and in vitro studies. Data on 67 patients, including 4 fatalities, were reviewed. Based on the summary of cases reported in the included articles, the cure rate of CBZ poisoning after symptomatic treatment was 82% and the efficiency of hemoperfusion was 58.2%. Based on the literature review, CBZ is moderately dialyzable and the recommendation for CBZ poisoning is supportive management and gastric lavage. In severe cases, extracorporeal treatment is recommended, with hemodialysis as the first choice.

Keywords: Carbamazepine poisoning, Management, Activated charcoal therapy, Extracorporeal treatment, Intravenous lipid emulsion

Core Tip: There is no effective Antidote and standard treatment management for carbamazepine (CBZ) poisoning. This paper describes and summarizes the detailed clinical evidence of the treatment and management of CBZ poisoning, including gastric lavage and activated carbon therapy, hemoplavage, hemodialysis, continuous renal replacement treatment and plasmapheresis. Finally, this paper also provides the lipid resuscitation therapy to provide help for clinical treatment. In general, this paper summarized the results of CBZ poisoning related research, and provided the best plan for CBZ poisoning treatment.