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2016 ; 81
(3
): 482-7
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Activated charcoal for acute overdose: a reappraisal
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Br J Clin Pharmacol
2016[Mar]; 81
(3
): 482-7
PMID26409027
show ga
Sometimes mistakenly characterized as a 'universal antidote,' activated charcoal
(AC) is the most frequently employed method of gastrointestinal decontamination
in the developed world. Typically administered as a single dose (SDAC), its
tremendous surface area permits the binding of many drugs and toxins in the
gastrointestinal lumen, reducing their systemic absorption. Like other
decontamination procedures, the utility of SDAC attenuates with time, and,
although generally safe, it is not free of risk. A large body of evidence
demonstrates that SDAC can reduce the absorption of drugs and xenobiotics but
most such studies involve volunteers and have little generalizability to clinical
practice. Few rigorous clinical trials of SDAC have been conducted, and none
validate or refute its utility in those patients who are intuitively most likely
to benefit. Over the past decade, a growing body of observational data have
demonstrated that SDAC can elicit substantial reductions in drug absorption in
acutely poisoned patients. The challenge for clinicians rests in differentiating
those patients most likely to benefit from SDAC from those in whom meaningful
improvement is doubtful. This is often a difficult determination not well suited
to an algorithmic approach. The present narrative review summarizes the data
supporting the benefits and harms of SDAC, and offers pragmatic suggestions for
clinical practice.
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