Efficacy of superactivated charcoal administered late (3 hours) after acetaminophen overdose

AASLD position paper: The management of acute liver failure

“…While it is most effective if given within one hour of ingestion, 12 it may be of benefit as long as 3 to 4 hours after ingestion. 13 Administration of activated charcoal (standard dose 1g/kg orally, in a slurry) just prior to administration of N-acetylcysteine does not reduce the effect of N-acetylcysteine. 13 N-acetylcysteine (NAC), the antidote for acetaminophen poisoning, has been shown to be effective and safe for this purpose in numerous controlled trials.…”

“…13 Administration of activated charcoal (standard dose 1g/kg orally, in a slurry) just prior to administration of N-acetylcysteine does not reduce the effect of N-acetylcysteine. 13 N-acetylcysteine (NAC), the antidote for acetaminophen poisoning, has been shown to be effective and safe for this purpose in numerous controlled trials. [15][16][17][18] The standard acetaminophen toxicity nomogram 19 may aid in determining the likelihood of serious liver damage, but cannot be used to exclude possible toxicity due to multiple doses over time, or altered metabolism in the alcoholic or fasting patient.…”

Efficacy of activated charcoal administered more than four hours after acetaminophen overdose

“…A number of authors have stated there is no evidence to support its use if more than 1, 2, or 4 h post-ingestion has passed (2)(3)(4)(5)(6). This opinion is not universally shared (7)(8)(9)(10). The two studies to evaluate this issue in acetaminophen overdose patients have concluded that late administration of activated charcoal provided an additional hepato-protective effect when compared with patients treated with NAC alone (7,8).…”

Activated charcoal: To give or not to give?

“…According to the NICE (2004) guidelines every patient who attends hospital with an overdose within 1 h should be given activated charcoal. Unfortunately there are many potential delays, according to Sato et al (2003), patients usually attend hospital several hours post ingestion, which rules out administration of charcoal. Another difficulty is obtaining an accurate history from the patient or delays within the ED which results in delays in administration of charcoal (Karim et al, 2001).…”