The medallion has 10 charges, and can be recharged by dipping it into the blood pool, in the cave where the medallion was originally found. The cave is found just south of the bank in Burgh de Rott. Upon charging it, you receive the message, You dip the medallion in the pool. The symbol glows as it recharges.
Teleporting to the above places from anywhere within the land of Morytania (which includes Canifis, Port Phasmatys, Mos Le'Harmless, and underground areas) does not use any charges and may even be done when the amulet has 0 charges. However, teleporting out of Temple Trekking/Burgh de Rott Ramble, from Paterdomus, or from any other part of RuneScape uses one charge. Therefore, if one wants to save or negate the need for charges, it is a good idea to use the Ectophial to teleport to Port Phasmatys or to use the Canifis Lodestone and then use the medallion to teleport to the desired location. This effectively gives the medallion an unlimited amount of charges.
The medallion is extremely useful for teleporting about Morytania, since no charges are used when teleporting in most places there. It allows quick banking at Burgh de Rott and quick prayer recharging at the altar in Darkmeyer. This is particularly useful for players doing Barrows, as banking and prayer recharging are both needed to do multiple runs of that minigame. Be aware that the Vyres in Darkmeyer will attack a player going to the altar there unless the player is wearing the Darkmeyer disguise. However, Protect from/Deflect Melee will partially protect the player from the attacks.
During the quest, the medallion is first discovered in a coffin, and is called mysterious medallion. It is later enchanted by Safalaan to create Drakan's medallion.
On release, teleporting from the slime pit, from inside the Barrows, or within the Shade Catacombs caused the medallion to use a charge. All these locations have now been fixed. Teleporting during the Temple Trekking minigame still uses up a charge, however.
This item has the third most teleport charges on a rechargeable item, after the sceptre of the gods that can have up to 20 and after the mighty slayer helmet that can hold up to 40 ring of slaying charges and 30 ferocious ring charges.
The "Submerge medallion" option on the blood pool uses a space rather than a hyphen, unlike many other right click options.
Teleporting from the Abbey of St. Elspeth Citharede with the medallion will not use a charge. This is most likely due to its proximity with Morytania.