Adsorbents

Activated charcoal

Activated charcoal is an effective adsorbent of many medications and of certain active metabolites excreted in the bile. Certain agents are not well adsorbed by charcoal (Table d). Charcoal administration is rarely associated with side-effects, although pulmonary aspiration may be quite serious. It should not be administered in the presence of ileus. Rather than relying on a fixed dose of activated charcoal, it is recommended that the dose exceed the mass of the drug by a factor of 10. In practice, however, the initial dose given is of the order of 1 to 2 g/kg body weight.

Table 4 Some toxins for which activated charcoal is ineffective

Repeated doses of activated charcoal have been proposed for many drugs (T§ble..,.5), but are perhaps most useful for those which have important enterohepatic recirculation (phenobarbital (phenobarbitone), phenytoin, colchicine, theophylline). This pulsed-dose method of charcoal administration has been shown to be effective in reducing the elimination half-lives of some drugs (phenobarbital) and the toxicity of others (theophylline), although positive results are not uniform.

Table 5 Drugs for which multiple doses of activated charcoal may be appropriate

It is extremely important in pulsed dosing to use activated charcoal without associated laxatives following the first daily dose. Multiple doses of cathartics may result in severe diarrhea and dehydration as well as electrolyte disorders.

Other adsorbents

Fuller's earth has been suggested in paraquat poisoning, althoughactivated charcoal is effective in its absence. Immediate adsorbent therapy is of utmost importance in this intoxication and should be instituted with a readily available adsorbent. Prussian blue (potassium ferric hexacyanoferrate) 250 mg/kg/day in four divided oral doses is effective for thallium and cesium poisoning, although pharmaceutical preparations may be impossible to obtain in some countries.

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