Among the following anticonvulsant agents, which would be expected to exhibit the most worrisome cardiotoxicity in an acute overdose? A) phenytoin B) cannabidiol C) levitriacetam D) carbemazepine E) perampanel
D) Carbamazepine. Carbamazepine is active at voltage gated sodium channels, and shares structural similarities to the tricyclic acid antidepressant (TCA) class of medications. In addition to both atrial and ventricular dysrhythmias that can occur with acute overdose, there is also an increase in likelihood of sudden cardiac arrest among individuals who use carbamazepine chronically. Consideration for cardiac monitoring should be given during acute overdose events.
Jia L, Eroglu TE, Wilders R, Verkerk AO, Tan HL. Carbamazepine Increases the Risk of Sudden Cardiac Arrest by a Reduction of the Cardiac Sodium Current. Front Cell Dev Biol. 2022 Jun 3;10:891996. doi: 10.3389/fcell.2022.891996. PMID: 35721495; PMCID: PMC9204209.
Contributed by Joe Kennedy, MD UVM Toxicology