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Activated Charcoal Decreases the Risk of QT Prolongation After Citalopram Overdose

Isbister, GK, Friberg, LE, Stokes, B, Buckley, NA, Lee, C, Gunja, N, Brown, SG, MacDonald, E, Graudlns, A, Holdgate, A and Duffull, SB (2007). Activated Charcoal Decreases the Risk of QT Prolongation After Citalopram Overdose. Annals of Emergency Medicine,50(5 (e46)):593-600.

Document type: Journal Article
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Title Activated Charcoal Decreases the Risk of QT Prolongation After Citalopram Overdose
Author Isbister, GK
Friberg, LE
Stokes, B
Buckley, NA
Lee, C
Gunja, N
Brown, SG
MacDonald, E
Graudlns, A
Holdgate, A
Duffull, SB
Journal Name Annals of Emergency Medicine
Publication Date 2007
Volume Number 50
Issue Number 5 (e46)
ISSN 0196-0644   (check CDU catalogue open catalogue search in new window)
Start Page 593
End Page 600
Total Pages 8
Place of Publication US
Publisher Mosby
Field of Research 1103 - Clinical Sciences
HERDC Category C1 - Journal Article (DEST)
Abstract Study objective: We determine whether single-dose activated charcoal (SDAC) administration after citalopram overdose reduces the proportion of patients developing abnormal QT prolongation.

Methods: Data were collected retrospectively for citalopram overdose patients presenting to 8 emergency departments. Demographics, dose, coingested drugs, SDAC administration, and serial ECGs were extracted from medical records. The primary outcome was the proportion of patients who had an observed QT,RR combination at any time above an abnormal threshold, established as a predictor of torsade de pointes. We compared the proportion of patients with QT prolongation who received or did not receive SDAC. These data were analyzed within a Bayesian framework, using probabilities of abnormal QT,RR combinations with and without
derived from a previous single-center study. WinBUGS was used to generate posterior estimates and credible intervals of the relative risk by combining the prior probabilities and the study data.

Results: SDAC was administered on average 2.1 hours (range, 0.5 to 6.25 hours) after ingestion in 48 of 254 admissions, and abnormal QT,RR combinations occurred in 2 cases (4.2%), compared with 23 of 206 (11.2%) cases not receiving SDAC. There did not appear to be any clinically important difference in age, sex, dose, and cardiotoxic coingestants between the 2 groups. No cases of torsade de pointes occurred. The estimated relative risk of having an abnormal QT,RR combination for SDAC compared to no SDAC was 0.28 (0.06 to 0.70) (median with 2.5% and 97.5% credible limits). The probability that the relative risk was less than 1.0 was 0.99, which can be interpreted as very strong evidence in favor of a beneficial effect of SDAC. The absolute risk difference was estimated as 7.5% and the median number needed to treat as 13.3.

Conclusion: SDAC may be effective in reducing the risk of a prolonged QT in patients after citalopram overdose. Current trends toward nonuse of activated charcoal should be evaluated to determine whether patients poisoned by specific agents may benefit from activated charcoal administration.
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