Markedly Elevated Carbamazepine-10,11-epoxideCarbamazepine Ratio in a Fatal Carbamazepine Ingestion

Abstract EN

Carbamazepine is a widely used anticonvulsant.

Its metabolite, carbamazepine-10,11-epoxide, has been found to display similar anticonvulsant and neurotoxic properties.

While the ratio of parent to metabolite concentration varies significantly, at therapeutic doses the epoxide concentration is generally about 20% of the parent.

We report a case of fatal carbamazepine overdose in which the epoxide metabolite concentration was found to be 450% higher than the parent compound, suggesting a potential role for metabolite quantification in severe toxicity.