Gut decontamination, including whole-bowel irrigation, may be necessary for amatoxins. Beyond the first postprandial hour, orogastric lavage is not recommended, because of its questionable efficacy. Activated charcoal plays a much more important role in limiting absorption of most toxins and is indicated for all patients with amatoxin mushroom poisoning, regardless of the timing of presentation. When amatoxins are suspected, multiple doses of activated charcoal should be administered repeatedly to interrupt enterohepatic circulation of these toxins.