Multiple doses of activated charcoal: time for reappraisal?

Multiple-dose charcoal therapy has become a popular treatment for many overdoses. It is generally perceived as a simple, inexpensive, effective, and safe procedure that decreases morbidity and mortality by enhancing drug excretion. However, increased drug clearance has been shown definitively for only a few drugs, and improved outcome has not been demonstrated conclusively for any overdose. Recently, there have been several reports of complications due to this intervention. The role of this pharmacologic curiosity in the management of the acutely poisoned patient requires reassessment.