Effect of Purgatives on Antidotal Efficacy of Oral Activated Charcoal

Abstract

<jats:p> 1 The effects of purgatives on the antidotal efficacy of oral activated charcoal were studied in seven volunteer subjects. </jats:p><jats:p> 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. </jats:p><jats:p> 3 The plasma concentrations (0-24 h) and the cumulative urinary excretion (0-72 h) of salicylates, atenolol and phenylpropanolamine were measured. </jats:p><jats:p> 4 Both magnesium citrate and metoclopramide combined with bisacodyl hastened the gastrointestinal transit but magnesium citrate was more effective. </jats:p><jats:p> 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. </jats:p><jats:p> 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. </jats:p><jats:p> 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. </jats:p>

<i>In Vitro</i> Evaluation of the Interaction Between Activated Charcoal and <i>N</i>-Acetylcysteine after Acetaminophen Adsorption

“…We then evaluated whether or not the adsorption of APAP and NAC onto AC competed with each other. Because the gastrointestinal transit time of AC was about 7 h, 11) NAC was added to the AC and APAP mixed suspension in 3 parts corresponding to the loading dose and 2 times of the maintenance doses. The adsorption rate of APAP with NAC in SGF was ≥97.88%, and that in SIF was 99.00%.…”

“…10) However, the transit time of AC is several hours, even though a cathartic is given with the AC to enhance the elimination of the charcoal-poisoning complex. 11,12) If AC stays in the stomach and intestines, the NAC would likely be adsorbed onto the AC. The objective of this study was to evaluate the effect of AC on a 72-h oral regimen of NAC using in vitro methods.…”

Towards Safer and More Predictable Drug Treatment – Reflections from Studies of the First BCPT Prize Awardee

“…Klaus Olkkola, at present the Professor and Chairman of Anaesthesiology, Intensive Care, Emergency Care, and Pain Medicine at the University of Turku, Finland, started his scientific career as my first doctoral student by studying factors affecting the antidotal efficacy of activated charcoal. In these systematic studies, we explored the effect of charcoal dose , gastric contents , ethanol and gastric pH , and purgatives on the charcoal′s antidotal efficacy and confirmed the superiority of charcoal over ipecac in gastrointestinal decontamination .…”

Massive Atenolol, Lisinopril, and Chlorthalidone Overdose Treated with Endoscopic Decontamination, Hemodialysis, Impella Percutaneous Left Ventricular Assist Device, and ECMO

“…This overdose may have been fatal if EGD decontamination was not performed. Studies have shown atenolol, lisinopril, and chlorthalidone bind to charcoal [19], but there are not studies showing improved patient outcomes with its use. Charcoal alone is unlikely to have provided the same amount of benefit based on the quantity adhered to the gastric mucosa.…”