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Background: Although it is a commonly held tenet that drugs with anticholinergic action would prolong the duration of time for effective gastric decontamination after drug ingestion, there are no published data in support of this belief. The purpose of this study was to determine whether activated charcoal is more effective in the presence of anticholinergic activity. Methods: This was an IRB approved, human volunteer, randomized crossover study. Ten volunteers ingested 4.0 g of acetaminophen on three occasions at least one week apart. One ingestion served as a control. One hour after the other two ingestions, 50 g of activated charcoal in water was administered to each volunteer. These intervention limbs differed in that each volunteer received 0.01 mg/kg of atropine intramuscularly 15 minutes prior to acetaminophen dosing in one of them. Eight blood samples were taken over the initial 8 hours for HPLC analyses of serum for acetaminophen, which were used for calculation of pharmacokinetic parameters. Repeated measures ANOVA and Tukey's HSD test were used for statistical analyses. Results: Control pharmacokinetic parameters for acetaminophen were consistent with literature values. The mean AUC [+ or -] SD for the control, charcoal and atropine/charcoal groups were 258 [+ or -] 122, 206 [+ or -] 120, and 138 [+ or -] 88 mg/L.hr, respectively. The decreases of bioavailability were 20% for the charcoal and 47% for the atropine/charcoal groups. Charcoal was more effective when the subjects were pre-treated with atropine compared to charcoal without atropinization (p [is less than] 0.05). Conclusion: Our data support the belief that activated charcoal is more effective in the presence of anticholinergic activity., Tenenbein M, Green R, Sitar DS. University of Manitoba, Winnipeg, Manitoba, [...]

Background: In the recent AACT/EAPCCT position statement on activated charcoal it was stated that 'there are insufficient data to support or exclude its use after 1 hour of ingestion.' The purpose of this study was to determine the effectiveness of activated charcoal administered 1, 2, and 3 hours after drug ingestion. Methods: This was an IRB approved, human volunteer, randomized crossover study. Ten volunteers ingested 4.0 g of acetaminophen on four occasions at least one week apart. One ingestion served as a control and the other three as experimental ingestions with charcoal being administered at 1, 2, and 3 hours after acetaminophen dosing. Eight blood specimens were obtained over the initial 8 hours for serum acetaminophen concentrations (HPLC) which were used for calculation of routine pharmacokinetic parameters. Repeated measures ANOVA and Tukey's HSD test were used for statistical analysis. Results: Pharmacokinetic parameters for acetaminophen in our volunteers were consistent with literature values. The mean AUC [+ or -] SD for the control and the 1, 2, and 3 hour groups were 221 [+ or -] 54, 154 [+ or -] 71,206 [+ or -] 67, and 204 [+ or -] 58 mg/L.hr, respectively. The one hour group was the only one differing from control (p [is less than] 0.01). The decrease of bioavailibility at one hour was 30.3% which is similar to previous studies. Conclusion: Our data do not support the administration of activated charcoal at 2 hours or longer after drug overdose., Tenenbein M, Green R, Grierson R, Sitar DS. University of Manitoba, Winnipeg, Manitoba, [...]