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(37552484) [3] Sustained-release formulations: Guidelines state that charcoal may be useful even after 4 hours if evidence of ongoing absorption is present, e.g., an increasing acetaminophen concentration. (37552484) For an ingestion that was slightly beyond four hours ago, it might be reasonable to empirically give activated charcoal (especially if there is a delayed turnaround time on serial acetaminophen levels)