Charcoal, activated paracetamol overdose

In paracetamol overdose, it has been suggested that when an opioid is present there may be a potential role for the use of activated charcoal beyond the one-hour post ingestion, because of the delay in the absorption of paracetamol. It is also worth noting that maximum plasma levels may be delayed when assessing treatment options. 

Activated charcoal may be given as first aid if the patient presents within an hour of ingestion. Antidotal treatment is almost universally effective if administered within 6 hours of overdose. The serum paracetamol concentration measured between 4 and 16 hours determines whether antidotal treatment with acetylcysteine is required, but if a significant overdose has been taken and no result is available by 6 hours after overdose, antidote should be... 

Dextropropoxyphene Dextropropoxyphene, a drug of abuse, and any misuse or overdose of which causes intoxication if taken along with paracetamol or alcohol. The individual develops serious CNS depression leading to death.40-42 Adverse effects can be treated by gastric lavage and administration of activated charcoal and naloxone 43... 

Brok J et al Interventions for paracetamol (acetaminophen) overdoses. Cochrane Database Syst Rev2002 (3) CD003328. [PMID 12137690 ] (There are few randomized controlled trials of treatment, but oral activated charcoal and use of ftf-acetylcysteine is recommended, with no NAC regimen proven more effective than any other.)... 

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