Anticonvulsant Overdoses: Phenytoin, Carbamazepine, Lamotrigine, Topiramate and Gabapentin
First Things First (assess & treat for the following)
Phenytoin
- Airway management
- ABCs of resuscitation
- Toxicity can be caused by propylene glycol as a diluent in IV formulation, or by phenytoin itself.
- Propylene glycol causes myocardial depression and cardiac arrest.
- Mild to moderate phenytoin intoxication
- Nystagmus
- Ataxia
- Dysarthria
- Nausea/vomiting
- Diplopia
- Hyperglycemia
- Agitation
- Severe phenytoin intoxication
- Stupor/coma
- Respiratory arrest
- Seizures have been reported; however, this should prompt the investigation into other causes.
Carbamazepine
- Airway management
- ABCs of resuscitation
- Toxicity effects from:
- CNS depression
- Anticholinergic effects
- Cerebellar-vestibular brainstem function
- Mild to moderate overdose
- Ataxia
- Nystagmus
- Ophthalmoplegia
- Dyskinesia
- Mydriasis
- Sinus tachycardia
- Severe overdose
- Myoclonus
- Seizures
- Hyperthermia
- Coma
- Respiratory arrest
- Atrioventricular block
- QRS widening
- QT prolongation
Lamotrigine
- Airway management
- ABCs of resuscitation
- Clinical manifestations of overdose
- Lethargy
- Dizziness
- Ataxia
- Stupor
- Nystagmus
- Hypertonia
- Seizures
- QRS prolongation
- Nausea/vomiting
- Hypokalemia
Topiramate
- Airway management
- ABCs of resuscitation
- Manifestations of overdose:
- CNS depression
- Confusion
- Slurred speech
- Ataxia
- Weakness
- Tremor
- Clonus
- Seizures
Gabapentin
- Airway management
- ABCs of resuscitation
- Manifestations of overdose
- CNS depression
- Dizziness
- Ataxia
- Tremor
- Slurred speech
- Diplopia
- Tachycardia
- Hypotension or hypertension
- Diarrhea
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Last updated: April 17, 2010
Citation
"Anticonvulsant Overdoses: Phenytoin, Carbamazepine, Lamotrigine, Topiramate and Gabapentin." Pocket ICU Management, PocketMedicine.com, Inc, 2010. Anesthesia Central, anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534173/all/Anticonvulsant_Overdoses:_Phenytoin__Carbamazepine__Lamotrigine__Topiramate_and_Gabapentin.
Anticonvulsant Overdoses: Phenytoin, Carbamazepine, Lamotrigine, Topiramate and Gabapentin. Pocket ICU Management. PocketMedicine.com, Inc; 2010. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534173/all/Anticonvulsant_Overdoses:_Phenytoin__Carbamazepine__Lamotrigine__Topiramate_and_Gabapentin. Accessed October 4, 2024.
Anticonvulsant Overdoses: Phenytoin, Carbamazepine, Lamotrigine, Topiramate and Gabapentin. (2010). In Pocket ICU Management. PocketMedicine.com, Inc. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534173/all/Anticonvulsant_Overdoses:_Phenytoin__Carbamazepine__Lamotrigine__Topiramate_and_Gabapentin
Anticonvulsant Overdoses: Phenytoin, Carbamazepine, Lamotrigine, Topiramate and Gabapentin [Internet]. In: Pocket ICU Management. PocketMedicine.com, Inc; 2010. [cited 2024 October 04]. Available from: https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534173/all/Anticonvulsant_Overdoses:_Phenytoin__Carbamazepine__Lamotrigine__Topiramate_and_Gabapentin.
* Article titles in AMA citation format should be in sentence-case
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