Severe overdosage with the antiepileptic drug oxcarbazepine

Opstal, J. M. Van; Janknegt, R.; Cilissen, J.; L’Ortije, W. H. V. M.; Nel, J. E.; Heer, F.

doi:10.1111/j.1365-2125.2004.02129.x

Cited by 21 publications

(11 citation statements)

References 8 publications

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“…Effects from overdose typically consist of varying degrees of sedation. Even a massive overdose may have relatively low toxicity (16). Treatment is generally supportive, as there is no specific antidote.…”

Section: Overdosementioning

confidence: 99%

Emergent Complications of the Newer Anticonvulsants

Wade

Dang

Nelson

et al. 2010

The Journal of Emergency Medicine

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Section: Overdosementioning

confidence: 99%

Emergent Complications of the Newer Anticonvulsants

Wade

Dang

Nelson

et al. 2010

The Journal of Emergency Medicine

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“…Very few cases of OXC overdose have been reported to date [6][7][8][9]. In all of them, central nervous system depression was rapidly induced and all patients fully recovered with symptomatic and supportive treatment.…”

Section: Figurementioning

confidence: 99%

“…Furlanut [7] and Van Opstal [9] reported MHD serum peak levels of 59 and 65 mg l -1 , despite massive OXC overdoses of 31 and 42 g, respectively; this was also the case in our patient (overdose around 15 g; MHD maximum serum level 46.6 mg l -1 ).The formation of MHD from OXC is a ratelimiting process and this probably contributes to the relatively low MHD levels after acute OXC intoxication [11]. Whether the clinical findings and benign evolution of OXC overdose would have been different with higher MHD serum levels remains unknown.…”

Section: Figurementioning

confidence: 99%

“…In clinical practice, the most commonly observed adverse events are rash, fatigue, nausea and somnolence [4]. Only four cases of OXC acute overdose have been reported to date [6][7][8][9], none of them in a paediatric patient. We describe the case of a 13-year-old boy who presented with somnolence after the ingestion of 15 g of OXC, and provide concomitant serum concentrations of both OXC and MHD.…”

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confidence: 99%

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Acute oxcarbazepine overdose in an autistic boy

Pedrini

Noguera

Vinent

et al. 2009

Brit J Clinical Pharma

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Oxcarbazepine (OXC), a 10-keto analogue of carbamazepine, is an antiepileptic drug licensed for the treatment of partial seizures in children and adults, as monotherapy or adjunctive therapy [1]. In humans, OXC is rapidly metabolized in liver to 10-monohydroxy-carbazepine (MHD), its active metabolite. MHD blocks voltage-sensitive sodium channels, stabilizing hyperexcited neuronal membranes, thereby inhibiting repetitive firing and decreasing the propagation of synaptic impulses [2]. Recently, successful use of OXC in the management of disruptive behaviours in autistic patients has also been reported [3].Despite the fact that experience with OXC in the paediatric age is still limited, several observational studies indicate that the drug has a good long-term tolerability profile [4,5]. In clinical practice, the most commonly observed adverse events are rash, fatigue, nausea and somnolence [4]. Only four cases of OXC acute overdose have been reported to date [6][7][8][9], none of them in a paediatric patient. We describe the case of a 13-year-old boy who presented with somnolence after the ingestion of 15 g of OXC, and provide concomitant serum concentrations of both OXC and MHD.A 13-year-old boy (weight 60 kg, height 175 cm) was brought to the Emergency Department by his mother because of accidental ingestion of 250 ml of Trileptal™ suspension (OXC solution, 60 mg l -1 ; Novartis, Barcelona, Spain) 1 h before; he had vomited shortly after the intake. No other drugs had been ingested. The patient had been diagnosed with autism spectrum disorder at the age of 4 years and was receiving risperidone (1 mg three times a day; Risperdal Flas™, Janssen-Cilag, Madrid, Spain) from the age of 10 years, together with behaviour modification. Treatment with OXC (300 mg twice daily) had been implemented 6 months earlier to treat persistent aggression towards others and head banging, with good tolerance to treatment and improvement in his disruptive behaviour.On admission, the patient's vital signs were as follows: blood pressure 105/47; pulse 75 beats min -1 ; respiratory rate 15 breaths min -1 ; haemoglobin saturation while breathing room air, 99%; temperature 36.9°C. He was somnolent (minimal Glasgow Coma Scale 13) but arousable to pain stimuli. Normal tendon and pupillary reflexes were present. Nystagmus and tremor were not observed; gait disturbances were not evaluable. The rest of the physical examination was unremarkable. The ECG was within normal limits (sinus rhythm, QRS 85 ms, and QTc 410 ms), and laboratory testing showed normal values for complete blood count, blood gases, protein and albumin levels, kidney and liver functions, and electrolyte concentrations.

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“…O nly a limited number of articles have appeared in the literature regarding intoxication with oxcarbazepine (OXC), [1][2][3] and only one of these has reported serum levels of the drug and its active derivative, monohydroxycarbazepine (MHD). 3 Furthermore, no information is available concerning the role that dialysis may play in severe OXC intoxications.…”

mentioning

confidence: 99%

Acute Oxcarbazepine, Benazepril, and Hydrochlorothiazide Overdose With Alcohol

Furlanut

Franceschi

Poz

et al. 2006

Therapeutic Drug Monitoring

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An epiletic patient, suffering from partial complex seizures and hypertension, ingested approximately 42 g of oxcarbazepine (OXC) and an undefined number of tablets containing an association of benazepril and hydrochlorothiazide along with some glasses of wine. Four hours later he was brought to the emergency room. He was stuporous and gradually became unconscious. Therefore he was intubated and, approximately 6 hours after the overdose, transferred to the intensive care unit, where he underwent a 4-hour hemodialysis. Even if this procedure did not accelerate the elimination of the prodrug nor its active metabolite (monohydrocarbazepine), 3 hours after the end of dialysis the patient was fully recovered.

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Severe overdosage with the antiepileptic drug oxcarbazepine

Cited by 21 publications

References 8 publications

Emergent Complications of the Newer Anticonvulsants

Emergent Complications of the Newer Anticonvulsants

Acute oxcarbazepine overdose in an autistic boy

Acute Oxcarbazepine, Benazepril, and Hydrochlorothiazide Overdose With Alcohol

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