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Expanded Role of Charcoal Therapy in the Poisoned and Overdosed Patient

Expanded Role of Charcoal Therapy in the Poisoned and Overdosed Patient Abstract • Activated charcoal is widely used as an adsorbent for the management of patients with drug overdoses and poisonings. Activated charcoal can be used orally to prevent drug and poison absorption in cases of overdose and poisoning. Multiple oral doses of charcoal increase the elimination of several, but not all, drugs and poisons. The effectiveness of multiple oral doses of charcoal in accelerating drug clearance is dependent primarily on the endogenous clearance of the drug or poison and its volume of distribution. Multiple doses of charcoal are used to shorten the period of supportive care in certain patients or to more rapidly remove drugs or poisons that may cause tissue damage, eg, theophylline. Charcoal is a safe, effective, and inexpensive alternative to more invasive treatments for some cases of drug overdose and poisoning. (Arch Intern Med 1986;146:969-973) References 1. Spector R: Poisoning and overdose , in Spector R (ed): The Scientific Basis of Clinical Pharmacology: Principles and Examples . Boston, Little Brown & Co, in press. 2. Cooney DO: Activated Charcoal: Antidotal and Other Medical Uses . New York, Marcel Dekker Inc, 1980. 3. Cooney DO: A `superactive' charcoal for antidotal use in poisonings. Clin Toxicol 1977;11:387-390.Crossref 4. Van de Graaff WB, Thompson WL, Sunshine I, et al: Adsorbent and cathartic inhibition of enteral drug absorption. J Pharmacol Exp Ther 1982;221:656-663. 5. Park GD, Spector R, Goldberg MJ, et al: Effect of the surface area of activated charcoal on theophylline clearance. J Clin Pharmacol 1984;24: 289-292.Crossref 6. Krenzelok EP: Comparison of cathartics used with activated charcoal, abstracted. Vet Hum Toxicol 1984;26:402. 7. Red Book . Oradell, NJ, Medical Economics Books, 1984. 8. Okonek S, Weilemann LS, Majdandzic J, et al: Successful treatment of paraquat poisoning: Activated charcoal per os and 'continuous hemoperfusion.' J Toxicol Clin Toxicol 1982;19:807-819.Crossref 9. Caldwell JH, Greenburger NJ: Interruption of the enterohepatic circulation of digitoxin by cholestyramine: I. Protection against lethal digitoxin intoxication. J Clin Invest 1971;50:2626-2637.Crossref 10. Bazzano G, Bazzano GS: Digitalis intoxication: Treatment with a new steroid-binding resin. JAMA 1972;220:828-830.Crossref 11. Guzelian PS: Therapeutic approaches for chlordecone poisoning in humans. J Toxicol Environ Health 1981;8:757-766.Crossref 12. Neuvonen PJ, Vartiainen M, Tokola O: Comparison of activated charcoal and ipecac syrup in prevention of drug absorption. Eur J Clin Pharmacol 1983;24:557-562.Crossref 13. Neuvonen PJ, Olkkola KT: Activated charcoal and syrup of ipecac in prevention of cimetidine and pindolol absorption in man after administration of metoclopramide as an antiemetic agent. Clin Toxicol 1984;22:103-114.Crossref 14. Curtis RA, Barone J, Giacona N: Efficacy of ipecac and activated charcoal/cathartic: Prevention of salicylate absorption in a simulated overdose. Arch Intern Med 1984;144:48-52.Crossref 15. Kulig K, Bar-Or D, Cantrill SV, et al: Management of acutely poisoned patients without gastric emptying. Ann Emerg Med 1985;14:562-567.Crossref 16. Chin L, Picchioni AL, Bourn WM, et al: Optimal antidotal dose of activated charcoal. Toxicol Appl Pharmacol 1973;26:103-108.Crossref 17. Neuvonen PJ, Olkkola KT: Effect of dose of charcoal on the absorption of disopyramide, indomethacin and trimethoprim by man. Eur J Clin Pharmacol 1984;26:761-767.Crossref 18. Levy G, Tsuchiya T: Effect of activated charcoal on aspirin absorption in man: I. Clin Pharmacol Ther 1972;13:317-322. 19. Neuvonen PJ, Elfving SM, Elonen E: Reduction of absorption of digoxin, phenytoin and aspirin by activated charcoal in man. Eur J Clin Pharmacol 1978;13:213-218.Crossref 20. Neuvonen PJ, Elonen E: Effect of activated charcoal on absorption and elimination of phenobarbitone, carbamazepine and phenylbutazone in man. Eur J Clin Pharmacol 1980;17:823-827.Crossref 21. Olkkola KT, Neuvonen PJ: Do gastric contents modify antidotal efficacy of oral activated charcoal? Br J Clin Pharmacol 1984;18:663-669.Crossref 22. Shore PA, Brodie BB, Hogben CAM: The gastric secretion of drugs: A pH partition hypothesis. J Pharmacol Exp Ther 1957;119:361-369. 23. Hart LG, Guarina AM, Schanker LS: Gastric dialysis as a possible antidotal procedure for removal of absorbed drugs. J Lab Clin Med 1969;73:853-859. 24. Lalonde RL, Deshpande R, Hamilton PP, et al: Acceleration of digoxin clearance by activated charcoal. Clin Pharmacol Ther 1985;37:367-371.Crossref 25. Goldberg MJ, Berlinger WG: Treatment of phenobarbital overdose with activated charcoal. JAMA 1982;247:2400-2401.Crossref 26. Berg MJ, Berlinger WG, Goldberg MJ, et al: Acceleration of the body clearance of phenobarbital by oral activated charcoal. N Engl J Med 1982; 307:642-644.Crossref 27. Neuvonen PJ, Elonen E, Haapanen EJ: Acute dapsone intoxication: Clinical findings and effect of oral charcoal and haemodialysis on dapsone elimination. Acta Med Scand 1983;214:215-220.Crossref 28. Berlinger WG, Spector R, Goldberg MJ, et al: Enhancement of theophylline clearance by oral activated charcoal. Clin Pharmacol Ther 1983;33:351-354.Crossref 29. Radomski L, Park GD, Goldberg MJ, et al: Model for theophylline overdose treatment with oral activated charcoal. Clin Pharmacol Ther 1984;35:402-408.Crossref 30. Goldberg MJ, Park GD, Spector R, et al: No effect of oral activated charcoal on imipramine clearance. Clin Pharmacol Ther , in press. 31. Park GD, Goldberg MJ, Spector R, et al: The effects of activated charcoal on digoxin and digitoxin clearance. Drug Intell Clin Pharm , in press. 32. Council on Scientific Affairs: Dietary and pharmacologic therapy for the lipid risk factors. JAMA 1983;250:1873-1879.Crossref 33. Pederson JA, Matter BJ, Czerwinski AW, et al: Relief of idiopathic generalized pruritus in dialysis patients treated with activated oral charcoal. Ann Intern Med 1980;93:446-448.Crossref 34. Friedman EA: Sorbents in the management of uremia. Am J Med 1976;60:614-618.Crossref 35. Lauterbach F: Intestinal secretion of organic ions and drugs , in Kramer M, Lauterbach F (eds): Intestinal Permeation: Proceedings of the Fourth Workshop Conference Hoechst . Amsterdam, Excerpta Medica, 1977, pp 173-193. 36. Storstein L: Studies on digitalis: III. Biliary excretion and enterohepatic circulation of digitoxin and its cardioactive metabolites. Clin Pharmacol Ther 1975;17:313-320. 37. Takki S, Gambertoglio JG, Honda DH, et al: Pharmacokinetic evaluation of hemodialysis in acute drug overdose. J Pharmacokin Biopharm 1978;5:427-442.Crossref 38. Park GD, Radomski L, Goldberg MJ, et al: Effects of size and frequency of oral doses of charcoal on theophylline clearance. Clin Pharmacol Ther 1983;34:663-666.Crossref 39. Klein-Schwartz W, Oderda GM: Adsorption of oral antidotes for acetaminophen poisoning (methionine and N-acetylcysteine) by activated charcoal. Clin Toxicol 1981;18:283-290.Crossref 40. North DS, Peterson RG, Krenzelok EP: Effect of activated charcoal administration on acetylcysteine serum levels in humans. Am J Hosp Pharm 1981;38:1022-1024. 41. Crome P, Dawling S, Braithwaite RA, et al: Effect of activated charcoal on absorption of nortriptyline. Lancet 1977;2:1203-1205.Crossref 42. Pond SM, Olson KR, Osterloh JD, et al: Randomized study of the treatment of phenobarbital with repeated doses of activated charcoal. JAMA 1984;251:3104-3108.Crossref 43. Du Souich P, Caillé G, Larochelle P: Enhancement of nadolol elimination by activated charcoal and antibiotics. Clin Pharmacol Ther 1983;33: 585-590.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Expanded Role of Charcoal Therapy in the Poisoned and Overdosed Patient

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1986.00360170207027
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Abstract

Abstract • Activated charcoal is widely used as an adsorbent for the management of patients with drug overdoses and poisonings. Activated charcoal can be used orally to prevent drug and poison absorption in cases of overdose and poisoning. Multiple oral doses of charcoal increase the elimination of several, but not all, drugs and poisons. The effectiveness of multiple oral doses of charcoal in accelerating drug clearance is dependent primarily on the endogenous clearance of the drug or poison and its volume of distribution. Multiple doses of charcoal are used to shorten the period of supportive care in certain patients or to more rapidly remove drugs or poisons that may cause tissue damage, eg, theophylline. Charcoal is a safe, effective, and inexpensive alternative to more invasive treatments for some cases of drug overdose and poisoning. (Arch Intern Med 1986;146:969-973) References 1. Spector R: Poisoning and overdose , in Spector R (ed): The Scientific Basis of Clinical Pharmacology: Principles and Examples . Boston, Little Brown & Co, in press. 2. Cooney DO: Activated Charcoal: Antidotal and Other Medical Uses . New York, Marcel Dekker Inc, 1980. 3. Cooney DO: A `superactive' charcoal for antidotal use in poisonings. Clin Toxicol 1977;11:387-390.Crossref 4. Van de Graaff WB, Thompson WL, Sunshine I, et al: Adsorbent and cathartic inhibition of enteral drug absorption. J Pharmacol Exp Ther 1982;221:656-663. 5. Park GD, Spector R, Goldberg MJ, et al: Effect of the surface area of activated charcoal on theophylline clearance. J Clin Pharmacol 1984;24: 289-292.Crossref 6. Krenzelok EP: Comparison of cathartics used with activated charcoal, abstracted. Vet Hum Toxicol 1984;26:402. 7. Red Book . Oradell, NJ, Medical Economics Books, 1984. 8. Okonek S, Weilemann LS, Majdandzic J, et al: Successful treatment of paraquat poisoning: Activated charcoal per os and 'continuous hemoperfusion.' J Toxicol Clin Toxicol 1982;19:807-819.Crossref 9. Caldwell JH, Greenburger NJ: Interruption of the enterohepatic circulation of digitoxin by cholestyramine: I. Protection against lethal digitoxin intoxication. J Clin Invest 1971;50:2626-2637.Crossref 10. Bazzano G, Bazzano GS: Digitalis intoxication: Treatment with a new steroid-binding resin. JAMA 1972;220:828-830.Crossref 11. Guzelian PS: Therapeutic approaches for chlordecone poisoning in humans. J Toxicol Environ Health 1981;8:757-766.Crossref 12. Neuvonen PJ, Vartiainen M, Tokola O: Comparison of activated charcoal and ipecac syrup in prevention of drug absorption. Eur J Clin Pharmacol 1983;24:557-562.Crossref 13. Neuvonen PJ, Olkkola KT: Activated charcoal and syrup of ipecac in prevention of cimetidine and pindolol absorption in man after administration of metoclopramide as an antiemetic agent. Clin Toxicol 1984;22:103-114.Crossref 14. Curtis RA, Barone J, Giacona N: Efficacy of ipecac and activated charcoal/cathartic: Prevention of salicylate absorption in a simulated overdose. Arch Intern Med 1984;144:48-52.Crossref 15. Kulig K, Bar-Or D, Cantrill SV, et al: Management of acutely poisoned patients without gastric emptying. Ann Emerg Med 1985;14:562-567.Crossref 16. Chin L, Picchioni AL, Bourn WM, et al: Optimal antidotal dose of activated charcoal. Toxicol Appl Pharmacol 1973;26:103-108.Crossref 17. Neuvonen PJ, Olkkola KT: Effect of dose of charcoal on the absorption of disopyramide, indomethacin and trimethoprim by man. Eur J Clin Pharmacol 1984;26:761-767.Crossref 18. Levy G, Tsuchiya T: Effect of activated charcoal on aspirin absorption in man: I. Clin Pharmacol Ther 1972;13:317-322. 19. Neuvonen PJ, Elfving SM, Elonen E: Reduction of absorption of digoxin, phenytoin and aspirin by activated charcoal in man. Eur J Clin Pharmacol 1978;13:213-218.Crossref 20. Neuvonen PJ, Elonen E: Effect of activated charcoal on absorption and elimination of phenobarbitone, carbamazepine and phenylbutazone in man. Eur J Clin Pharmacol 1980;17:823-827.Crossref 21. Olkkola KT, Neuvonen PJ: Do gastric contents modify antidotal efficacy of oral activated charcoal? Br J Clin Pharmacol 1984;18:663-669.Crossref 22. Shore PA, Brodie BB, Hogben CAM: The gastric secretion of drugs: A pH partition hypothesis. J Pharmacol Exp Ther 1957;119:361-369. 23. Hart LG, Guarina AM, Schanker LS: Gastric dialysis as a possible antidotal procedure for removal of absorbed drugs. J Lab Clin Med 1969;73:853-859. 24. Lalonde RL, Deshpande R, Hamilton PP, et al: Acceleration of digoxin clearance by activated charcoal. Clin Pharmacol Ther 1985;37:367-371.Crossref 25. Goldberg MJ, Berlinger WG: Treatment of phenobarbital overdose with activated charcoal. JAMA 1982;247:2400-2401.Crossref 26. Berg MJ, Berlinger WG, Goldberg MJ, et al: Acceleration of the body clearance of phenobarbital by oral activated charcoal. N Engl J Med 1982; 307:642-644.Crossref 27. Neuvonen PJ, Elonen E, Haapanen EJ: Acute dapsone intoxication: Clinical findings and effect of oral charcoal and haemodialysis on dapsone elimination. Acta Med Scand 1983;214:215-220.Crossref 28. Berlinger WG, Spector R, Goldberg MJ, et al: Enhancement of theophylline clearance by oral activated charcoal. Clin Pharmacol Ther 1983;33:351-354.Crossref 29. Radomski L, Park GD, Goldberg MJ, et al: Model for theophylline overdose treatment with oral activated charcoal. Clin Pharmacol Ther 1984;35:402-408.Crossref 30. Goldberg MJ, Park GD, Spector R, et al: No effect of oral activated charcoal on imipramine clearance. Clin Pharmacol Ther , in press. 31. Park GD, Goldberg MJ, Spector R, et al: The effects of activated charcoal on digoxin and digitoxin clearance. Drug Intell Clin Pharm , in press. 32. Council on Scientific Affairs: Dietary and pharmacologic therapy for the lipid risk factors. JAMA 1983;250:1873-1879.Crossref 33. Pederson JA, Matter BJ, Czerwinski AW, et al: Relief of idiopathic generalized pruritus in dialysis patients treated with activated oral charcoal. Ann Intern Med 1980;93:446-448.Crossref 34. Friedman EA: Sorbents in the management of uremia. Am J Med 1976;60:614-618.Crossref 35. Lauterbach F: Intestinal secretion of organic ions and drugs , in Kramer M, Lauterbach F (eds): Intestinal Permeation: Proceedings of the Fourth Workshop Conference Hoechst . Amsterdam, Excerpta Medica, 1977, pp 173-193. 36. Storstein L: Studies on digitalis: III. Biliary excretion and enterohepatic circulation of digitoxin and its cardioactive metabolites. Clin Pharmacol Ther 1975;17:313-320. 37. Takki S, Gambertoglio JG, Honda DH, et al: Pharmacokinetic evaluation of hemodialysis in acute drug overdose. J Pharmacokin Biopharm 1978;5:427-442.Crossref 38. Park GD, Radomski L, Goldberg MJ, et al: Effects of size and frequency of oral doses of charcoal on theophylline clearance. Clin Pharmacol Ther 1983;34:663-666.Crossref 39. Klein-Schwartz W, Oderda GM: Adsorption of oral antidotes for acetaminophen poisoning (methionine and N-acetylcysteine) by activated charcoal. Clin Toxicol 1981;18:283-290.Crossref 40. North DS, Peterson RG, Krenzelok EP: Effect of activated charcoal administration on acetylcysteine serum levels in humans. Am J Hosp Pharm 1981;38:1022-1024. 41. Crome P, Dawling S, Braithwaite RA, et al: Effect of activated charcoal on absorption of nortriptyline. Lancet 1977;2:1203-1205.Crossref 42. Pond SM, Olson KR, Osterloh JD, et al: Randomized study of the treatment of phenobarbital with repeated doses of activated charcoal. JAMA 1984;251:3104-3108.Crossref 43. Du Souich P, Caillé G, Larochelle P: Enhancement of nadolol elimination by activated charcoal and antibiotics. Clin Pharmacol Ther 1983;33: 585-590.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: May 1, 1986

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