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Gastric lavage in aspirin and non-steroidal anti-inflammatory drug overdose

Three Part Question

[In overdose with aspirin or other non steroidals] is [gastric lavage better than charcoal or nothing] at [reducing toxicity]?

Clinical Scenario

A 53 year old widow attends the emergency department having taken 20 aspirin and 20 ibuprofen one and a half hours previously. You remember that non-steroidals slow gastric emptying and wonder whether gastric lavage would be of use in toxicity reduction.

Search Strategy

Medline 1966-05/04 using the OVID interface.
[{exp gastric lavage OR gastirc OR exp gastric emptying OR gastric OR exp irrigation OR OR empt$.mp OR irrigat$.af OR OR} AND {exp poisoning OR exp overdose OR exp suicide OR exp Self-Injurious Behavior/ OR poiso$.af OR overdos$.af OR suicid$.af OR (deliberate adj5 self adj5 harm).af OR} AND {exp aspirin OR exp anti-inflammatory agents, non-steroidal OR salic$.af OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR mefenamic OR OR OR OR OR OR exp piroxicam OR OR OR OR tiaprofenic}] LIMIT to Human AND English language.

Search Outcome

Altogether 72 papers found 71 of which failed to answer the three part question. A further reference was found after scanning of references. The 2 papers are shown below.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Danel V et al,
12 healthy volunteers given 1.5g aspirin acting as own controls treated with nothing, charcoal and lavageProspective controlled studySalicylate recovered in urine over 24hControl 13.3% lavage 8.8% charcoal 7.0%Statistical significance not assessed Dose fairly small Number of patients small
Lapatto-Reiniluoto O et al,
9 healthy volunteers as own controls given 400mg ibuprofen. Treated with water (control), charcoal or charcoal followed by lavageProspective controlled trialAUC plasma ibuprofen as % of controlControl 100% charcoal alone 70% (p<0.05) charcoal + lavage 51% (p<0.05) No statiscal significance between control groupsSmall numbers Therapeutic ibuprofen dose


There are no large scale trials performed in this area, however those that exist show that at best lavage is no better if not slightly worse than charcoal at reducing salicylate toxicity. Lavage although better than nothing has an element of risk involved in its practice and charcoal must therefore be treatment of choice.

Editor Comment

Search repeated on 8/11/03. No new papers found. For UK position statement on gastric lavage see

Clinical Bottom Line

Gastic lavage is no better than charcoal alone at reducing toxicity following aspirin or NSAID overdose.

Level of Evidence

Level 3 - Small numbers of small studies or great heterogeneity or very different population.


  1. Danel V, Henry JA, Gluckman E. Activated charcoal,emesis and gastric lavage in aspirin overdose. BMJ 1988;296:1507.
  2. Lapatto-Reinoluoto O, Kivisto T, Neuvonen PJ. Effect of activated charcoal alone or given after gastric lavage in reducing the absorption of diazepam, ibuprofen and citalopram. Br J Clin Pharmacol 1999;48:148-53.