To the Editor:
We read with interest the recent study regarding the effect of anticholinergic drugs on the efficacy of activated charcoal in the setting of a drug overdose Citation1. We were pleased to note that the issue of activated charcoal administration beyond 1 h is being considered.
The position statement put forth by the American Academy of Clinical Toxicology and the European Association of Poison Centres and Clinical Toxicologists recommends that the administration of activated charcoal be considered in patients who have ingested a potentially toxic amount of a poison, known to be adsorbable to charcoal, within 1 h Citation2. Although there are insufficient data to support its use after 1 h of ingestion of a poison, the authors of the position statement clearly state that there are also no data to support the exclusion of its use after 1 h. It is reasonable to administer activated charcoal to patients several hours after a potentially toxic amount of a poison with the hope of preventing a fatal outcome.
Green et al. provide data supporting the hypothesis that activated charcoal is more effective in the presence of anticholinergic agents. However, this effect was demonstrated in a pretreatment model using parenteral atropine. In order to have clinical relevance, these effects need to be shown using oral dosing of commonly used anticholinergic agents given concomitantly with, and after, acetaminophen dosing. We also look forward to future studies addressing the possible benefit of activated charcoal administration beyond 1 h after drug overdose. However, we must stress that despite a lack of data supporting a benefit, activated charcoal should be administered to sick patients who have a potentially lethal overdose.
Authors:
Beth Y. Ginsburg, M.D.*
New York University School of Medicine
New York City Poison Control Center
Inna Leybell, M.D.
New York University School of Medicine
Robert S. Hoffman, M.D.
New York University School of Medicine/New York City Poison Control Center
*Corresponding author
References
- Green R, Sitar D S, Tenenbein M. Effect of anticholinergic drugs on the efficacy of activated charcoal. J Toxicol, Clin Toxicol 2004; 42:267–272.
- Chyka P A, Seger D. Position statement: single-dose activated charcoal. American Academy of Clinical Toxicology; European Association of Poison Centres and Clinical Toxicologists. J Toxicol, Clin Toxicol 1997; 35:721–741.