Effect of charcoal‐drug ratio on antidotal efficacy of oral activated charcoal in man.

Olkkola, KT

doi:10.1111/j.1365-2125.1985.tb02712.x

Cited by 39 publications

(25 citation statements)

References 13 publications

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“…Therefore, in the initial management of intoxicated patients large doses (50 to 100g) of charcoal should be used (Neuvonen & Olkkola 1984a;Olkkola 1985b .s 50 Charcoal/drug ratio (g/g) Charcoal/drug ratio (g/g) acids at a low pH and bases at a high pH (Andersen 1947;Hauge & Willamann 1927). The higher the charcoalpoison ratio, the more complete is the adsorption.…”

Section: Effects Of Charcoal Dosementioning

confidence: 99%

“…In humans 50g of charcoal prevented the absorption of over 90% of therapeutic doses (200mg) of disopyramide (Neuvonen & Olkkola 1984a). The efficacy of charcoal is also likely to be at least moderate in intoxications, but it should be given in as high doses as feasible to minimise the potential risk of saturation of its adsorption capacity (figs 1 and 7).…”

Section: Disopyramidementioning

confidence: 99%

“…The effect of charcoal on the Fig. From Berlinger et al (1983). coal inhibits the gastrointestinal absorpt ion of, for example, tetracycline, doxycycline and trimethoprim (Neuvonen & Olkkola 1984a;Neuvonen et al 1983c;Venho et al 1978). Serum theophylline concentrations after intravenous infusion of aminophylline (6 mg/kg) with (e) and without (0) activated charcoal (40g at 0 hours and 20g at 2.…”

Section: Oral Antihyperglycaemic Drugsmentioning

confidence: 99%

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Oral Activated Charcoal in the Treatment of Intoxications

1988

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Activated charcoal has an ability to adsorb a wide variety of substances. This property can be applied to prevent the gastrointestinal absorption of various drugs and toxins and to increase their elimination, even after systemic absorption. Single doses of oral activated charcoal effectively prevent the gastrointestinal absorption of most drugs and toxins present in the stomach at the time of charcoal administration. Known exceptions are alcohols, cyanide, and metals such as iron and lithium. In general, activated charcoal is more effective than gastric emptying. However, if the amount of drug or poison ingested is very large or if its affinity to charcoal is poor, the adsorption capacity of activated charcoal can be saturated. In such cases properly performed gastric emptying is likely to be more effective than charcoal alone. Repeated dosing with oral activated charcoal enhances the elimination of many toxicologically significant agents, e.g. aspirin, carbamazepine, dapsone, dextropropoxyphene, cardiac glycosides, meprobamate, phenobarbitone, phenytoin and theophylline. It also accelerates the elimination of many industrial and environmental intoxicants. In acute intoxications 50 to 100g activated charcoal should be administered to adult patients (to children, about 1 g/kg) as soon as possible. The exceptions are patients poisoned with caustic alkalis or acids which will immediately cause local tissue damages. To avoid delays in charcoal administration, activated charcoal should be a part of first-aid kits both at home and at work. The 'blind' administration of charcoal neither prevents later gastric emptying nor does it cause serious adverse effects provided that pulmonary aspiration in obtunded patients is prevented. In severe acute poisonings oral activated charcoal should be administered repeatedly, e.g. 20 to 50g at intervals of 4 to 6 hours, until recovery or until plasma drug concentrations have fallen to non-toxic levels. In addition to increasing the elimination of many drugs and toxins even after their systemic absorption, repeated doses of charcoal also reduce the risk of desorbing from the charcoal-toxin complex as the complex passes through the gastrointestinal tract. Charcoal will not increase the elimination of all substances taken. However, as the drug history in acute intoxications is often unreliable, repeated doses of oral activated charcoal in severe intoxications seem to be justified unless the toxicological laboratory has identified the causative agent as not being prone to adsorption by charcoal. The role of repeated doses of oral activated charcoal in chronic intoxication has not been clearly defined.(ABSTRACT TRUNCATED AT 400 WORDS)

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Section: Effects Of Charcoal Dosementioning

confidence: 99%

Section: Disopyramidementioning

confidence: 99%

Section: Oral Antihyperglycaemic Drugsmentioning

confidence: 99%

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Oral Activated Charcoal in the Treatment of Intoxications

1988

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“…Some reports suggest that the adsorption of drugs to activated charcoal in the gastrointestinal tract may be reversible in man Neuvonen et al, 1978;Olkkola, 1985). In the treatment of a poisoned patient saline purgatives are recommended as an adjunct to charcoal to hasten elimination of charcoal-poison complex (Oderda, 1979;Rumack, 1980;Daunderer, 1983;Cupit & Temple, 1984;Teschke, 1984;Boehnert et al , 1985;Krenzelok, 1985).…”

Section: Introductionmentioning

confidence: 97%

Effect of Purgatives on Antidotal Efficacy of Oral Activated Charcoal

Neuvonen

Olkkola

1986

Human Toxicology

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1 The effects of purgatives on the antidotal efficacy of oral activated charcoal were studied in seven volunteer subjects. 2 The volunteer subjects were given 1000 mg of aspirin, 100 mg of atenolol and 50 mg of phenylpropanolamine with 100 ml of water on an empty stomach and were assigned randomly to the following treatment groups: (A) after 5 min 150 ml of water, (B) after 5 min 25 g of charcoal, (C) after 5 min charcoal orally with 20 mg of metoclopramide rectally, followed by 10 mg of bisacodyl rectally 3 h afterwards, (D) after 5 min charcoal with 250 ml of magnesium citrate USP and (E) after 60 min charcoal with metoclopramide followed by bisacodyl 3 h thereafter. 3 The plasma concentrations (0-24 h) and the cumulative urinary excretion (0-72 h) of salicylates, atenolol and phenylpropanolamine were measured. 4 Both magnesium citrate and metoclopramide combined with bisacodyl hastened the gastrointestinal transit but magnesium citrate was more effective. 5 Charcoal alone reduced the absorption of aspirin and phenylpropanolamine by about 50% and that of atenolol by about 95%. The purgatives did not modify significantly the efficacy of charcoal. 6 When the antidotal treatment was delayed by 60 min its efficacy was reduced to some extent, possibly depending on the pharmaceutical formulation of the test drugs. 7 The present results do not support the routine use of purgatives in combination with activated charcoal. In some instances, however, their use may promote the evacuation of, for example, depot formulations from the gastrointestinal tract and thus have a beneficial effect together with activated charcoal in reducing absorption.

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“…Activated charcoal binds optimally to medications when provided in a 10:1 activated charcoal (AC) to drug ratio or greater [30]. In cases of massive ingestion, the amount of AC given is not capable of binding all of the acetaminophen in the stomach.…”

Section: Treatment Considerations and Controversiesmentioning

confidence: 99%

Bactrian (“Double Hump”) Acetaminophen Pharmacokinetics: A Case Series and Review of the Literature

et al. 2010

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After acute ingestion, acetaminophen (APAP) is generally absorbed within 4 h and the APAP concentration ([APAP]) slowly decreases with a predictable half-life. Alterations in these pharmacokinetic principles have been rarely reported. We report here three cases of an unusual double hump, or Bactrian, pattern of [APAP]. We review the literature to describe the case characteristics of these rare cases. A 38-year-old woman ingested 2 g hydrocodone/65 g acetaminophen. Her [APAP] peaked at 289 mcg/mL (8 h), decreased to 167 mcg/mL (31 h), then increased to 240 mcg/mL (39 h). She developed liver injury (peak AST 1603 IU/L; INR1.6). A 25-year-old man ingested 2 g diphenhydramine/26 g APAP. His [APAP] peaked at 211 mcg/mL (15 h), decreased to 185 mcg/mL (20 h), and increased again to 313 mcg/mL (37 h). He developed liver injury (peak AST 1153; INR 2.1). A 16-year-old boy ingested 5 g diphenhydramine and 100 g APAP. His [APAP] peaked at 470 mcg/mL (25 h), decreased to 313 mcg/mL (36 h), then increased to 354 mcg/mL (42 h). He developed liver injury (peak AST 8,686 IU/L; peak INR 5.9). We report three cases of Bactrian ("double hump") pharmacokinetics after massive APAP overdoses. Cases with double hump pharmacokinetics may be associated with large ingestions (26-100 g APAP) and are often coingested with antimuscarinics or opioids. Several factors may contribute to these altered kinetics including the insolubility of acetaminophen, APAP-induced delays in gastric emptying, opioid or antimuscarinic effects, or enterohepatic circulation. Patients with double hump APAP concentrations may be at risk for liver injury, with AST elevations and peaks occurring later than what is typical for acute APAP overdoses.

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Effect of charcoal‐drug ratio on antidotal efficacy of oral activated charcoal in man.

Cited by 39 publications

References 13 publications

Oral Activated Charcoal in the Treatment of Intoxications

Oral Activated Charcoal in the Treatment of Intoxications

Effect of Purgatives on Antidotal Efficacy of Oral Activated Charcoal

Bactrian (“Double Hump”) Acetaminophen Pharmacokinetics: A Case Series and Review of the Literature

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