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Best evidence topic report
Activated charcoal in tricyclic antidepressant overdose
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  1. Claire Park,
  2. Katrina Richell-Herren
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL

    http://dx.doi.org/10.1136/emj.17.2.128

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      Report by Claire Park, Medical Student Search checked by Katrina Richell-Herren, Research Fellow

      Clinical scenario

      A 25 year old woman attends the emergency department having taken an overdose of amitriptyline. You wonder whether she will benefit from treatment with activated charcoal.

      Three part question

      In [adults who have taken a tricyclic antidepressant (TCA) overdose] is [activated charcoal] effective at [reducing drug absorption and reducing complication rates]?

      Search strategy

      Medline 1966 to 12/99 using the OVID interface. ([Exp antidepressant, tricyclic OR tricyclic$.mp OR TCA$.mp OR exp desipramine OR exp nortriptyline OR desipramine OR amitriptyline] AND [exp charcoal OR charcoal.mp]) LIMIT to human AND english.

      Search outcome

      Altogether 79 papers were found of which 69 were irrelevant and six of insufficient quality for inclusion. The remaining four papers are shown in table 3

      Comment

      There are two types of study reported. The first is experimental and shows significant effect from rapid administration of charcoal to volunteers taking therapeutic doses of TCAs. The second type is clinical and show no benefit from charcoal administered at various times after overdose of TCAs. However both clinical studies use low charcoal doses after gastric lavage.

      Clinical bottom line

      There is no convincing evidence that activated charcoal is effective in preventing TCA absorption or complication rates after TCA overdose. More work is needed in this area.

      Report by Claire Park, Medical Student Search checked by Katrina Richell-Herren, Research Fellow

      References

      1. Crome P, Dawlings S, Braithwaite RA, et al. Effect of activated charcoal on the absorption of nortriptyline. Lancet1977;ii:1203–5.
      2. Crome P, Adams R, Ali C, et al. Activated charcoal in tricyclic antidepressant poisoning: pilot controlled clinical trial. Human Toxicol1983;2:205–9.
        OpenUrlPubMedWeb of Science
      3. Karkkainen S, Neuvonin PJ. Pharmacokinetics of amitriptyline influenced by oral charcoal and urinary pH. Int J Clin Pharmacol1986;24:326–32.
        OpenUrl
      4. Hulten BA, Adams R, Askenasi R, et al. Activated charcoal in tricyclic antidepressant poisoning. Human Toxicology1988;7:307–10.
        OpenUrlPubMedWeb of Science