Activated Charcoal in Drug Overdose A Review Presenters

Activated Charcoal in Drug Overdose: A Review Presenters: Cheyenne Caldwell, Katelyn Corcoran, Haley Kirchner Mentor: Dr. Dale Wurster, Ph. D.

ACTIVATED CHARCOAL ▸ Treatment of drug overdose for decades ▸ Not very many studies on the reason for administration ▸ Administration of activated charcoal to a patient is not pleasant ▸ Propose that a compendium be created Figure 1. Activated Charcoal. Adapted from “Charcoal business booms in Ondo, ” by R. Bamgbose, 2016, News Agency of Nigeria. Retrieved September, 17, 2018, from http: //www. nan. ng/business/charcoalbusiness-booms-ondo/. 2

WHY? Figure 2. Trauma Room Stare Down. Adapted from “Board Vitals, ” by Board. Vitals Writing Staff, January 8, 2016, Board Vitals. Retrieved September, 17, 2018, from https: //www. boardvitals. com/blog/emergency-medicine-exam-sample-questions/ 3

GOAL To determine which medications that activated charcoal should/shouldn't be administered for in the event of an emergency overdose ▸ 4

OBJECTIVE ▸ ▸ Evaluate research studies that demonstrate whether or not the administration of activated charcoal is effective at absorbing different drugs. Create a compendium that list the specific scientific studies that demonstrate the effectiveness of administrating activated charcoal for treatment of drug overdose. 5

METHODS Figure 3. Behind the lab work. Adapted from “Wikipedia Commons, ” by M. Diepi, February 5 th 2013, Wikipedia Commons. Retrieved September, 17 th, 2018, from https: //commons. wikimedia. org/wiki/File: Behind_the_lab_work. jpg 6

METHODS SEARCH TERMS EMBASE ▸ ('activated carbon'/exp OR 'activated carbon') AND ('drug overdose'/exp OR 'drug overdose') AND effectiveness ▸ ('single drug dose'/exp OR 'single drug dose') AND ('activated carbon'/exp OR 'activated carbon') AND ('drug overdose'/exp OR 'drug overdose') ▸ ('single drug dose'/exp OR 'single drug dose') AND ('activated carbon'/exp OR 'activated carbon') AND ('drug overdose'/exp OR 'drug overdose’) ▸ single AND dose AND charcoal 7

METHODS SEARCH TERMS PUBMED ▸ Charcoal[Mesh] AND "Drug Overdose"[Mesh] ▸ "Pharmacokinetics"[Mesh] AND "Charcoal"[Mesh] AND "Drug Overdose"[Mesh] AND ("2007/12/23"[PDat] : "2017/12/19"[PDat]) ▸ ("Charcoal"[Mesh]) AND "Drug Overdose"[Mesh] ▸ "Pharmacokinetics"[Mesh] AND "Charcoal"[Mesh] AND "Drug Overdose"[Mesh] 8

METHODS Inclusion ▸ ▸ ▸ January 1 st, 2008 -Present Primary sourced studies ▹ Randomized control studies ▹ Case controls ▹ Cohort studies Peer-reviewed journals analyzed for bias and credibility Exclusion ▸ ▸ ▸ Multi-drug-based studies Hemodialysis use of activated charcoal Studies outside of time frame Secondary and tertiary sourced resources Patient case report studies 9

RESULTS? 10 Figure 4. Physics Math. Adapted from “Celestial Body Swimwear, ” Celestial Body. Retrieved September, 17 th, 2018, from https: //www. celestialbodyswimwear. com/products/andromeda-high-waist-bottom-equations

RESULTS Table 1. Activated Charcoal’s Efficacy on Medication Studies Examined Drugs Tested Efficacy Page et al[1] Promethazine + Wang et al[2] Apixaban + Van Gorp et al[3] Escitalopram + Cooper et al[4] Sertraline +++ Duffull et al[5] Gude et al[6[ Acetaminophen + / +++ Cumpston et al[7] Phenytoin --- KEY - - - No efficacy + Potential Efficacy +++ Proven Efficacy 11

CONCLUSION 12 Figure 5. Emergency Room Sign. Adapted from ”Medical Secrets, ” by fortipress, October 17 th, 2017. Retrieved September, 19 th, 2018, from http: //medicalsecrets. com/blog/weed-related-emergency-room-visits-rise/

LIMITATIONS ▸ List isn’t complete – only certain key terms were analyzed ▸ Limited window – January 1 st - Present ▸ Hospitals have deferred away from using activated charcoal due to patient side effects ▸ Activated Charcoal is often used in combination with other medications for overdose treatment – incredibly difficult to determine which drug had the overdose benefit 13

NEXT STEPS 14

REFERENCES 1. Page, C. , Duffull, S. , Whyte, I. , & Isbister, G. (2009). Promethazine overdose: Clinical effects, predicting delirium and the effect of charcoal. QJM: An International Journal of Medicine, 102(2), 123 -131. doi: 10. 1093/qjmed/hcn 153 2. Wang, X. , Mondal, S. , Wang, J. , Tirucherai, G. , Zhang, D. , Boyd, R. A. , & Frost, C. (2014). Effect of Activated Charcoal on Apixaban Pharmacokinetics in Healthy Subjects. American Journal of Cardiovascular Drugs, 14(2), 147 -154. doi: https: //doi. org/10. 1007/s 40256013 -0055 -y 15

REFERENCES 3. Gorp, F. V. , Duffull, S. , Hackett, L. P. , & Isbister, G. K. (2012). Population pharmacokinetics and pharmacodynamics of escitalopram in overdose and the effect of activated charcoal. British Journal of Clinical Pharmacology, 73(3), 402 -410. doi: 10. 1111/j. 1365 -2125. 2011. 04091. x 4. Cooper, J. M. , Duffull, S. B. , Saiao, A. S. , & Isbister, G. K. (2015). The pharmacokinetics of sertraline in overdose and the effect of activated charcoal. British Journal of Clinical Pharmacology, 79(2), 307315. doi: 10. 1111/bcp. 12500 5. Duffull, S. B. , & Isbister, G. K. (2013). Predicting the requirement for Nacetylcysteine in paracetamol poisoning from reported dose. Clinical Toxicology, 51(8), 772 -776. doi: 10. 3109/15563650. 2013. 830733 16

REFERENCES 6. Gude, A. J. , Hoegberg, L. C. , Angelo, H. R. , & Christensen, H. R. (2009). Dose-Dependent Adsorptive Capacity of Activated Charcoal for Gastrointestinal Decontamination of a Simulated Paracetamol Overdose in Human Volunteers. Basic & Clinical Pharmacology & Toxicology, 106(5), 406 -410. doi: 10. 1111/j. 1742 -7843. 2009. 00503. x 7. Cumpston, K. , Stromberg, P. , Wills, B. K. , & Rose, S. R. (2016). Activated Charcoal Does Not Reduce Duration of Phenytoin Toxicity in Hospitalized Patients. American Journal of Therapeutics, 23(3), 773 -777. doi: 10. 1097/mjt. 000000058 17

Activated Charcoal in Drug Overdose: A Review Presenters: Cheyenne Caldwell, Katelyn Corcoran, Haley Kirchner Mentor: Dr. Dale Wurster, Ph. D. 18 Figure 1. Activated Charcoal. Adapted from “Charcoal business booms in Ondo, ” by R. Bamgbose, 2016, News Agency of Nigeria. Retrieved September, 17, 2018, from http: //www. nan. ng/business/charcoalbusiness-booms-ondo/.