Carbamazepine Clearance in Hemodialysis and Hemoperfusion

Abstract

A 47-year-old woman with endstage renal disease and dialysis-induced encephalopathy was being treated with carbamazepine for myoclonus. Her carbamazepine serum concentration appeared to be therapeutic at 5.1 micrograms/ml. She experienced a seizure while on hemodialysis/hemoperfusion that was possibly related to the removal of carbamazepine during dialysis. The elimination of carbamazepine on a dialysis day was compared with elimination on a nondialysis day. The half-life and apparent clearance were the same for each day, indicating that hemodialysis/hemoperfusion had little effect on the overall removal of carbamazepine from the body. The possible reasons for this lack of effect are discussed.

Hemodialysis Is as Effective as Hemoperfusion for Drug Removal in Carbamazepine Poisoning

“…In a previous case study [6]where the efficacy of both HD and CHP was performed in a patient, these two procedures were found to be equally effective in an end-stage renal disease (ESRD) patient. Another report [7]of 4 ESRD patients found that the dialytic process in chronic HD patients cleared CBZ about twice as fast as the reported mean clearance of CBZ, while in another case report [8]the combined therapy of HD and CHP reduced the blood CBZ level by 50%.…”

Successful treatment of carbamazepine poisoning with hemodialysis: A case report and review of the literature

“…There are few reports comparing hemodialysis with hemoperfusion in the treatment of carbamazepine poisoning. In a previous case study where both were performed in a patient, these 2 procedures were found to be equally effective in an end‐stage renal failure patient 26 . In another report, these 2 modalities were compared in a patient with normal renal function.…”

“…In a previous case study where both were performed in a patient, these 2 procedures were found to be equally effective in an endstage renal failure patient. 26 In another report, these 2 modalities were compared in a patient with normal renal function. The efficacy of hemodialysis is manifested by an effective carbamazepine reduction ratio of 27.7%, whereas the reduction ratio of 3 hours hemoperfusion is 25.3%.…”

Continuous venovenous hemodiafiltration to treat controlled‐release carbamazepine overdose in a pediatric patient

“…Several modalities have been used for enhanced clearance of CBZ. Because CBZ is highly protein‐bound (80%) and has a large volume of distribution, conventional hemodialysis which is a diffusion‐based technique, may not be efficient in acute CBZ toxicity (8). For enhanced clearance charcoal hemoperfusion or albumin‐enhanced CVVHD are recommended which may be more effective in removing highly protein‐bound substances (9,10).…”