View source for Multidose activated charcoal

==Background==
*Method of enhanced elimination that uses multiple doses of activated charcoal
*No evidence to suggest that MDAC decreases morbidity or mortality
**Some evidence shows that MDAC increases the elimination of certain drugs (further explained below)
*Functions to prevents the absorption of xenobiotics that are slowly absorbed and to enhance the elimination of certain xenobiotics that have already been absorbed
**large amounts of xenobiotics ingested or dissolution is delayed (masses, bezoars)
**formulations that exhibit a delayed or prolonged release phase (enteric coated, extended release)
**GI motility is impaired 
**prevent reabsoprtion (enterohepatic circulation of active xenobiotic or metabolite)

==Dosing==
*12.5 g/hr in divided doses (eg. 50g Q4hr)
*Should avoid sorbitol-containing formulation in MDAC therapy, as may lead to electrolyte disturbance secondary to diarrhea

==Contraindications==
*Same as with [[Single Dose Activated Charcoal (SDAC)]]
*Intestinal obstruction (absolute)
*Decreased gut motility (relative)

==Indications==
*Mnemonic: ''T''hese ''P''eople ''D''rink ''C''harcoal ''Q''uickly
**Theophylline
**Phenobarbital
**Dapsone
**Carbamazepine
**Quinine
*There is also some evidence of utility of MDAC in salicylate overdose

==Mechanism of Action==
#Stops enterohepatic circulation 
#Increases passive diffusion and acts as a sink for the xenobiotics
#Binds drugs in extended release formulations

==See Also==
[[Activated Charcoal]]

==References==
<references/>
*http://www.clintox.org/documents/positionpapers/MultipleDoseActivatedCharcoal.pdf
*Uptodate

[[Category:Toxicology]]