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The prognosis in cases of severe poisoning is critically dependent upon prompt elimination of the drugwhich may be achieved by inducing vomitingirrigating the stomachand by taking appropriate steps to diminish absorptionIf these measures cannot be implemented without risk on the spotthe patient should be transferred at once to a hospitalwhile ensuring that vital functions are safeguardedThere is no specific antidote.

Monitoring of blood levels has increased the efficacy and safety of anticonvulsantssee PRECAUTIONSLaboratory TestsDosage should be adjusted to the needs of the individual patientA low initial daily dosage with a gradual increase is advisedAs soon as adequate control is achievedthe dosage may be reduced very gradually to the minimum effective levelMedication should be taken with meals.

Dialysis is indicated only in severe poisoning associated with renal failureReplacement transfusion is indicated in severe poisoning in small children.

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examples of these medications are carbamazepine tegretol and phenytoin dilantin .