Whole-bowel irrigation versus activated charcoal in sorbitol for the ingestion of modified-release pharmaceuticals

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Abstract
Overdose with modified-release pharmaceuticals is an increasing phenomenon. This study examines whole-bowed irrigation as a potential decontamination strategy after overdose with enteric-coated acetylsalicylic acid and compares it with administration of activated charcoal in sorbitol, which is currently the recommended intervention. A three-phase randomized crossover protocol was used in 10 adult volunteers. Each volunteer ingested nine 325 mg doses of enteric-coated acetylsalicylic acid on three occasions, with at least 1 week between each administration period. Serum samples were analyzed for salicylic acid concentration by HPLC. Both interventions decreased peak salicylic acid concentration, time-to-zero salicylic acid concentration, and AUC when compared with control (p < 0.01). Whole-bowel irrigation was superior to activated charcoal in sorbitol by all three criteria (p < 0.05). Adverse effects were qualitatively and quantitatively greater during activated charcoal in sorbitol that whole-bowel irrigation should be considered for overdose of other modified-release pharmaceuticals.

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