Multidose activated charcoal


  • 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)


  • 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



  • Mnemonic: These People Drink Charcoal Quickly
    • Theophylline
    • Phenobarbital
    • Dapsone
    • Carbamazepine
    • Quinine
  • There is also some evidence of utility of MDAC in salicylate overdose

Mechanism of Action

  1. Stops enterohepatic circulation
  2. Increases passive diffusion and acts as a sink for the xenobiotics
  3. Binds drugs in extended release formulations

See Also

Activated Charcoal