Q J Med doi:10.1093/qjmed/hci102
A randomized clinical trial of activated charcoal for
the routine management of oral drug overdose
G.M. COOPER1, D.G. LE COUTEUR, D. RICHARDSON and N.A. BUCKLEY
From the Pharmacy, University of Canberra, Bruce, 2Centre for Education and Research on Ageing and ANZAC Research Institute, University of Sydney, Concord Repatriation General Hospital, Concord, and Departments of 3Emergency Medicine and 4Clinical Pharmacology and Toxicology, Canberra Clinical School, The Canberra Hospital, Canberra, Australia
Received 23 November 2004 and in revised form 23 June 2005
Summary
Background: Activated charcoal (AC) is commonly
used for the routine management of oral drug overdose.
Aim: To determine whether the routine use of
activated charcoal has an effect on patient
outcomes.
Design: Randomized controlled unblinded trial.
Methods: We recruited all adult patients presenting
with an oral overdose at The Canberra Hospital,
excluding only transfers, late presenters, those
who had ingested drugs not adsorbed by activated
charcoal or where administration was contraindicated,
and very serious ingestions (at the discretion
of the admitting physician). Patients were randomized
to either activated charcoal or no decontamination.
Results: The trial recruited 327 patients over
16 months. Of 411 presentations, four refused
consent, 27 were protocol violations and 53 were
excluded from the trial. Only seven were
excluded due to the severity of their ingestion.
The most common substances ingested were
benzodiazepines, paracetamol and selective
serotonin reuptake inhibitor antidepressants.
More than 80% of patients presented within 4 h
following ingestion. There were no differences
between AC and no decontamination in terms of
length of stay (AC 6.75 h, IQR 414 vs. controls
5.5 h, IQR 312; p¼0.11) or secondary outcomes
including vomiting, mortality and intensive care
admission.
Discussion: Routine administration of charcoal
following oral overdose did not significantly influence
length of stay or other patient outcomes
following oral drug overdose. There were few
adverse events. This does not exclude a role in
patients who present shortly after ingestion of highly
lethal drugs.