Comparison of activated charcoal and ipecac syrup in prevention of drug absorption

Abstract

The efficacy of activated charcoal and ipecac syrup in the prevention of drug absorption was studied in 6 healthy adult volunteers, using a randomized, cross-over design. Paracetamol 1000 mg, tetracycline 500 mg and aminophylline 350 mg were ingested on an empty stomach with 100 ml water. Then, after 5 or 30 min, the subjects ingested, either activated charcoal suspension (50 g charcoal), syrup of ipecac, or, only after 5 min, water 300 ml. Activated charcoal, given either after 5 or 30 min, significantly (p less than 0.01 or less 0.05) reduced the absorption of these 3 drugs measured, for example as AUC0-24 h. Syrup of ipecac caused emesis on each occasion, with a mean delay of 15 min. When ipecac was given 5 min after the drugs, its effect on absorption was significant, but when it was given after 30 min only the absorption of tetracycline was reduced. Activated charcoal was significantly (p less than 0.05) more effective than ipecac in reducing drug absorption when given at the same time points. In cases of acute intoxication, depending on the quality and quantity of the drugs ingested, the relative efficacy of charcoal and ipecac may be somewhat different from that observed in the present study. Despite its emetic action, however, ipecac syrup is not very effective in preventing drug absorption and, in general, activated charcoal should also be given after induced emesis or gastric lavage.

Describing Adsorption of Paracetamol from Aqueous Solution on Carbons While Utilizing the Most Widespread Isotherm Models—The Impact of Surface Carbonyl and Basic Groups

“…[2] in (11)), Toth (T) (Eq. [3] in (11)), Fritz and Schluender (F-S) (Eq. [4] in (11)), Holl and Kirch (H-K) (Eq.…”

“…It is well known that oral charcoal can be successfully applied as an antidote in different intoxinations (1)(2)(3). The results of the detailed investigation into the influence of carbon surface chemical composition on adsorption (and the kinetics of this process) of 4-hydroxyacetanilide (paracetamol), an analgestic/antipyretic drug, from aqueous solution and at the neutral pH, were published recently (4)(5)(6)(7)(8).…”

Recent advances: Management of self poisoning

“…Beyond this time adsorption is reduced. 4 8 What constitutes a substantial amount of toxin depends on the toxin but in general it is a dose expected to cause moderate to severe toxicity. The guidelines do not apply to agents for which multiple dose charcoal would be beneficial or for substances that are not readily adsorbed to charcoal (box 1).…”

Lesson of the week: Deaths from low dose paracetamol poisoning

“…There is no evidence that activated charcoal is an effective treatment four hours after paracetamol overdose, 15 19 and apart from one case of a patient developing a toxic paracetamol concentration after an initial non-toxic concentration20 there is no evidence to recommend serial testing.…”