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Drug overview for ACTIVATED CHARCOAL (activated charcoal):
Generic name: ACTIVATED CHARCOAL
Drug class:
Therapeutic class: Antidotes and other Reversal Agents
Activated charcoal, which is used clinically as an adsorbent and antidote based on its adsorptive property, is the residue from the destructive distillation of various organic materials that has been treated to increase its adsorptive power.
No enhanced Uses information available for this drug.
Generic name: ACTIVATED CHARCOAL
Drug class:
Therapeutic class: Antidotes and other Reversal Agents
Activated charcoal, which is used clinically as an adsorbent and antidote based on its adsorptive property, is the residue from the destructive distillation of various organic materials that has been treated to increase its adsorptive power.
No enhanced Uses information available for this drug.
DRUG IMAGES
ACTIVATED CHARCOAL POWDER
The following indications for ACTIVATED CHARCOAL (activated charcoal) have been approved by the FDA:
Indications:
Unknown oral substance toxicity
Professional Synonyms:
Nonspecific toxicity from oral overdose
Indications:
Unknown oral substance toxicity
Professional Synonyms:
Nonspecific toxicity from oral overdose
The following dosing information is available for ACTIVATED CHARCOAL (activated charcoal):
The optimum dose of activated charcoal in the treatment of poisoning in pediatric patients has not been established. Some clinicians state that optimal adsorption appears to occur at a charcoal-to-toxin ratio of 10 to 1 or higher but that a fixed dose of 1 g/kg generally is recommended in children. A dose of 25-50 g or 0.5-1
g/kg of body weight given as a slurry in water has been recommended for children 1-12 years of age. Infants up to 1 year of age may receive 10-25 g or 0.5-1 g/kg.
Other clinicians suggest a dose of 15-30 g of activated charcoal in children with substantial overdoses of toxic substances when less than 1 hour has elapsed since ingestion. In children who have not swallowed the dose of activated charcoal within 20 minutes following ingestion of the toxic agent, some clinicians recommend that activated charcoal be administered through a nasogastric tube by personnel trained in the identification and treatment of complications of this procedure.
The usual dosage of activated charcoal used in multiple-dose therapy in children up to 13 years of age is 10-25 g initially, followed by 1-2 g/kg every 2-4 hours. An expert panel of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists (AACT/EAPCCT) states that doses of 10-25 g may be used in children younger than 5 years of age because of their smaller gut lumen capacity and the usually smaller overdoses in these individuals. Multiple-dose therapy with activated charcoal generally should be continued until the patient recovers or until major symptoms of toxicity resolve. An IV antiemetic may be necessary to minimize the risk of vomiting during administration of multiple doses of charcoal even when given by nasogastric tube.
g/kg of body weight given as a slurry in water has been recommended for children 1-12 years of age. Infants up to 1 year of age may receive 10-25 g or 0.5-1 g/kg.
Other clinicians suggest a dose of 15-30 g of activated charcoal in children with substantial overdoses of toxic substances when less than 1 hour has elapsed since ingestion. In children who have not swallowed the dose of activated charcoal within 20 minutes following ingestion of the toxic agent, some clinicians recommend that activated charcoal be administered through a nasogastric tube by personnel trained in the identification and treatment of complications of this procedure.
The usual dosage of activated charcoal used in multiple-dose therapy in children up to 13 years of age is 10-25 g initially, followed by 1-2 g/kg every 2-4 hours. An expert panel of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists (AACT/EAPCCT) states that doses of 10-25 g may be used in children younger than 5 years of age because of their smaller gut lumen capacity and the usually smaller overdoses in these individuals. Multiple-dose therapy with activated charcoal generally should be continued until the patient recovers or until major symptoms of toxicity resolve. An IV antiemetic may be necessary to minimize the risk of vomiting during administration of multiple doses of charcoal even when given by nasogastric tube.
Activated charcoal is administered orally or via nasogastric or orogastric tube. Activated charcoal powder can be administered as an extemporaneously prepared aqueous slurry or suspension and is commercially available as a suspension. Activated charcoal is most effective when administered early in the management of acute poisoning, preferably within 30-60 minutes of ingestion of the poison, although some benefit is possible with later administration in patients with gastric concretions or those who have ingested extended-release drugs or drugs that delay gastric emptying.
Continuous instillation of activated charcoal slurry into the duodenum via a small nasogastric tube may improve the retention of activated charcoal when an ingested agent produces protracted vomiting (e.g., theophylline). Tablets or granules of activated charcoal are less effective than the powdered form of the drug and should not be used in the treatment of poisonings. Many clinicians previously recommended that vomiting be induced with ipecac syrup before activated charcoal was administered.
However, because administration of ipecac syrup may delay the administration of activated charcoal and there is little evidence to demonstrate improved outcome with its use, most clinicians no longer recommend routine use of ipecac syrup in the emergency department or hospital setting. However, under rare circumstances, use of ipecac syrup in the home setting may be appropriate if not contraindicated and if recommended by a poison control center or other qualified clinician. (See Uses: Acute Poisoning, in Ipecac Syrup 56:20.) Although activated charcoal does not appear to diminish the emetic effects of ipecac syrup when given 10 minutes following the ipecac dose, vomiting should be completed before administration of activated charcoal.
(See Drug Interactions: Ipecac Syrup.) For extemporaneous preparation, activated charcoal powder should be mixed with sufficient tap water (e.g., 20-30 g in at least 240 mL) to form a slurry. Some clinicians state that more concentrated slurries generally should be avoided to minimize the risk of airway obstruction if aspiration occurs, to aid in dispersion of the charcoal, and possibly to increase palatability. Sorbitol may reduce the gritty sensation and improve the palatability of activated charcoal, and acts as a hyperosmotic laxative that may help prevent constipation associated with the drug.
Therefore, sorbitol has been used in the extemporaneous preparation of activated charcoal suspensions and is found in some commercial preparations. However, sorbitol should be administered only with single-dose activated charcoal or with the first dose of a multiple-dose regimen of the drug, and no more than 1 or 2 doses of sorbitol or another cathartic (if required) should be used in a 24-hour period because of the potential for dehydration, hypotension, and electrolyte disturbances (e.g., hypernatremia) associated with excessive catharsis. Sorbitol-containing preparations of activated charcoal should be used with caution in children and geriatric patients; hydration and electrolytes should be monitored with such use.
Also, if sorbitol is used with an initial dose of activated charcoal, a second cathartic generally should not be administered. Sorbitol content may vary between commercially available preparations of activated charcoal, and the label should be consulted to determine the amount of sorbitol contained in such products. The palatability of the activated charcoal slurry also can be improved by the addition of a thickening agent such as bentonite or carboxymethylcellulose.
Some evidence suggests that a small amount of a flavoring agent such as concentrated fruit juice or chocolate syrup may be added without substantially interfering with the adsorptive capacity of activated charcoal. However, some clinicians state that flavoring agents have been shown to decrease the adsorptive capacity of activated charcoal and generally should not be used. If chocolate syrup is used for flavoring, it should be added just prior to administration since the sweetness and flavor reportedly disappear after a few minutes of contact with activated charcoal.
Milk, ice cream, or sherbet should not be used as a vehicle for the administration of activated charcoal since the adsorptive capacity of activated charcoal was substantially decreased when ice cream (or sherbet) was mixed with activated charcoal in a 2.5:1 ratio by weight.
Continuous instillation of activated charcoal slurry into the duodenum via a small nasogastric tube may improve the retention of activated charcoal when an ingested agent produces protracted vomiting (e.g., theophylline). Tablets or granules of activated charcoal are less effective than the powdered form of the drug and should not be used in the treatment of poisonings. Many clinicians previously recommended that vomiting be induced with ipecac syrup before activated charcoal was administered.
However, because administration of ipecac syrup may delay the administration of activated charcoal and there is little evidence to demonstrate improved outcome with its use, most clinicians no longer recommend routine use of ipecac syrup in the emergency department or hospital setting. However, under rare circumstances, use of ipecac syrup in the home setting may be appropriate if not contraindicated and if recommended by a poison control center or other qualified clinician. (See Uses: Acute Poisoning, in Ipecac Syrup 56:20.) Although activated charcoal does not appear to diminish the emetic effects of ipecac syrup when given 10 minutes following the ipecac dose, vomiting should be completed before administration of activated charcoal.
(See Drug Interactions: Ipecac Syrup.) For extemporaneous preparation, activated charcoal powder should be mixed with sufficient tap water (e.g., 20-30 g in at least 240 mL) to form a slurry. Some clinicians state that more concentrated slurries generally should be avoided to minimize the risk of airway obstruction if aspiration occurs, to aid in dispersion of the charcoal, and possibly to increase palatability. Sorbitol may reduce the gritty sensation and improve the palatability of activated charcoal, and acts as a hyperosmotic laxative that may help prevent constipation associated with the drug.
Therefore, sorbitol has been used in the extemporaneous preparation of activated charcoal suspensions and is found in some commercial preparations. However, sorbitol should be administered only with single-dose activated charcoal or with the first dose of a multiple-dose regimen of the drug, and no more than 1 or 2 doses of sorbitol or another cathartic (if required) should be used in a 24-hour period because of the potential for dehydration, hypotension, and electrolyte disturbances (e.g., hypernatremia) associated with excessive catharsis. Sorbitol-containing preparations of activated charcoal should be used with caution in children and geriatric patients; hydration and electrolytes should be monitored with such use.
Also, if sorbitol is used with an initial dose of activated charcoal, a second cathartic generally should not be administered. Sorbitol content may vary between commercially available preparations of activated charcoal, and the label should be consulted to determine the amount of sorbitol contained in such products. The palatability of the activated charcoal slurry also can be improved by the addition of a thickening agent such as bentonite or carboxymethylcellulose.
Some evidence suggests that a small amount of a flavoring agent such as concentrated fruit juice or chocolate syrup may be added without substantially interfering with the adsorptive capacity of activated charcoal. However, some clinicians state that flavoring agents have been shown to decrease the adsorptive capacity of activated charcoal and generally should not be used. If chocolate syrup is used for flavoring, it should be added just prior to administration since the sweetness and flavor reportedly disappear after a few minutes of contact with activated charcoal.
Milk, ice cream, or sherbet should not be used as a vehicle for the administration of activated charcoal since the adsorptive capacity of activated charcoal was substantially decreased when ice cream (or sherbet) was mixed with activated charcoal in a 2.5:1 ratio by weight.
No dosing information available.
No generic dosing information available.
The following drug interaction information is available for ACTIVATED CHARCOAL (activated charcoal):
There are 0 contraindications.
There are 0 severe interactions.
There are 1 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| Xanthine Derivatives/Charcoal SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Theophylline is absorbed by activated charcoal.(1) The absorption results in decreased theophylline absorption from the gastrointestinal tract, decreased enterohepatic recirculation, and increased theophylline clearance.(1-14) CLINICAL EFFECTS: Theophylline absorption is decreased and clearance is increased as charcoal absorbs the theophylline. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: In a theophylline overdose the charcoal should be administered as soon as possible. Theophylline clearance may increase with continued administration. If the charcoal is not being given for theophylline overdose, a higher dose of theophylline should be given, or administration times should be separated. DISCUSSION: Activated charcoal is more effective than gastric lavage, emesis, or sorbitol catharsis and is considered first line therapy for sustained-release theophylline overdose.(15,16) Theophylline half-life has been reported to be decreased up to 52%, and clearance increased up to 96%. (5) Mean plasma level of a single dose of slow-release theophylline decreased by 39%.(2) Activated charcoal is also effective in treating aminophylline overdose.(17) |
AMINOPHYLLINE, DYPHYLLINE, ELIXOPHYLLIN, THEO-24, THEOPHYLLINE, THEOPHYLLINE ANHYDROUS, THEOPHYLLINE ER, THEOPHYLLINE ETHYLENEDIAMINE |
The following contraindication information is available for ACTIVATED CHARCOAL (activated charcoal):
Drug contraindication overview.
No enhanced Contraindications information available for this drug.
No enhanced Contraindications information available for this drug.
There are 2 contraindications.
Absolute contraindication.
| Contraindication List |
|---|
| Gastrointestinal obstruction |
| Gastrointestinal perforation |
There are 3 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Absence of bowel sounds |
| Gastrointestinal hemorrhage |
| Hypovolemia |
There are 0 moderate contraindications.
The following adverse reaction information is available for ACTIVATED CHARCOAL (activated charcoal):
Adverse reaction overview.
No enhanced Common Adverse Effects information available for this drug.
No enhanced Common Adverse Effects information available for this drug.
There are 2 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. | None. |
| Rare/Very Rare |
|---|
|
Abdominal distension Abdominal pain with cramps |
There are 3 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Black stools Diarrhea Vomiting |
None. |
| Rare/Very Rare |
|---|
| None. |
The following precautions are available for ACTIVATED CHARCOAL (activated charcoal):
No enhanced Pediatric Use information available for this drug.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
No enhanced Pregnancy information available for this drug.
No enhanced Lactation information available for this drug.
No enhanced Geriatric Use information available for this drug.
The following prioritized warning is available for ACTIVATED CHARCOAL (activated charcoal):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for ACTIVATED CHARCOAL (activated charcoal)'s list of indications:
| Unknown oral substance toxicity | |
| T65.91xA | Toxic effect of unspecified substance, accidental (unintentional), initial encounter |
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