title: Carbamazepine and the active epoxide metabolite are effectively cleared by hemodialysis followed by continuous venovenous hemodialysis in an acute overdose.
abstract: Hemodialysis (HD) and continuous venovenous hemodialysis (CVVHD) have an unproven role in the management of carbamazepine overdose. Albumin-enhanced CVVHD may accelerate carbamazepine (CBZ) clearance, but no pharmacokinetic data has been reported for traditional CVVHD without albumin enhancement. In addition, it is unclear whether the active CBZ-epoxide metabolite is removed with either mode of dialysis. We present a case of CBZ intoxication successfully managed with sequential HD and CVVHD. The CBZ half-life during CVVHD was 14.7 hours, compared with the patient's endogenous half-life of 30.8 hours. The CBZ-epoxide half-life was 3.2 hours during HD. We conclude that HD and CVVHD provide effective clearance of CBZ and the epoxide metabolite and should be considered in the management of an acute toxic ingestion.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, University of Michigan School of Medicine, Ann Arbor, Michigan 48109-0725, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Harder
authors.forename: Michael
authors.initials: M
authors.lastname: Heung
authors.forename: A Mary
authors.initials: AM
authors.lastname: Vilay
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Mueller
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Segal
mesh_terms: D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics*; D002220:Carbamazepine / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000493:pharmacokinetics*; D062787:Drug Overdose; D006207:Half-Life; D006801:Humans; D008297:Male; D006435:Renal Dialysis; D013997:Time Factors
chemical_list: D018712:Analgesics, Non-Narcotic; D002220:Carbamazepine; C012227:carbamazepine epoxide