Is activated charcoal (AC) administered in a naproxen (nonsteroidal anti-inflammatory drug) overdose?

Management of Naproxen Overdose: Role of Activated Charcoal

Activated charcoal should be administered in cases of naproxen overdose if the patient presents within 4 hours of ingestion. 1

Indications for Activated Charcoal in Naproxen Overdose

• Activated charcoal is specifically indicated in the FDA drug label for naproxen overdose management when patients present within 4 hours of ingestion 1
• The recommended dosage is 60-100g for adults and 1-2g/kg for children 1
• Activated charcoal works by adsorbing naproxen in the gastrointestinal tract, preventing further absorption of the drug 2

Timing Considerations

• The effectiveness of activated charcoal decreases significantly with time after ingestion 3
• Studies show that the reduction in drug absorption decreases to values of questionable clinical importance when charcoal is administered after one hour 3
• However, the FDA label for naproxen specifically extends this window to 4 hours for naproxen overdose 1

Administration Protocol

• Standard adult dose is 60-100g of activated charcoal given orally or via nasogastric tube 1
• Pediatric dose is 1-2g/kg body weight 4
• Activated charcoal should be administered as a slurry in water 4
• Formulations containing sorbitol as a cathartic should be used cautiously, especially in children, as hypernatremic dehydration has been reported after repeated doses 4

Clinical Considerations and Contraindications

• Ensure the patient has an intact or protected airway before administering activated charcoal to prevent aspiration 3
• Activated charcoal is contraindicated in patients with:
  • Compromised airway protective reflexes without endotracheal intubation 3
  • Active gastrointestinal bleeding 4
  • Risk of gastrointestinal perforation 5

Symptoms of Naproxen Overdose to Monitor

• Naproxen overdose may present with lethargy, dizziness, drowsiness, epigastric pain, abdominal discomfort, nausea, and vomiting 1
• More severe cases may involve gastrointestinal bleeding, hypertension, acute renal failure, respiratory depression, and rarely coma 1
• Monitor for transient alterations in liver function, hypoprothrombinemia, and metabolic acidosis 1

Additional Management Strategies

• Symptomatic and supportive care is the mainstay of treatment for naproxen overdose as there are no specific antidotes 1
• Hemodialysis is not effective due to high protein binding of naproxen 1
• Forced diuresis, alkalinization of urine, or hemoperfusion are not useful due to high protein binding 1
• An osmotic cathartic may be indicated in addition to activated charcoal for patients seen within 4 hours of ingestion 1

Practical Implementation Challenges

• In real-world settings, most overdose patients present to healthcare facilities more than one hour after ingestion, making it challenging to adhere to optimal timing guidelines 6
• Rapid triage and administration of activated charcoal should be prioritized to maximize effectiveness 6