Activated charcoal

U.S. BRAND NAMES — Actidose-Aqua® [OTC]; Actidose® with Sorbitol [OTC]; Char-Caps [OTC]; CharcoAid® G [OTC]; Charcoal Plus® DS [OTC]; CharcoCaps® [OTC]; EZ-Char™ [OTC]; Kerr Insta-Char® [OTC]; Requa® Activated Charcoal [OTC]

PHARMACOLOGIC CATEGORY
Antidote

DOSING: ADULTS
Acute poisoning:
Oral: 25-100 g as a single dose; if multiple doses are needed, additional doses may be given as 12.5 g/hour or equivalent (eg, 25 g every 2 hours)
Note: ~10 g of activated charcoal for each 1 g of toxin is considered adequate; this may require multiple doses. If sorbitol is also used, sorbitol dose should not exceed 1.5 g/kg. When using multiple doses of charcoal, sorbitol should be given with every other dose (not to exceed 2 doses/day)

Dietary supplement: Oral: 500-520 mg after meals; may repeat in 2 hours if needed (maximum: 10 g/day)

DOSING: PEDIATRIC

(For additional information see "Activated charcoal: Pediatric drug information")
Acute poisoning: Oral:
Children:
<1 year: 0.5-1 g/kg (10-25 g) as a single dose; if multiple doses are needed, give as 0.25 g/kg/hour or equivalent (eg, 0.5 g/kg every 2 hours)
1-12 years: 0.5-1 g/kg (25-50 g) as a single dose; if multiple doses are needed, give as 0.25 g/kg/hour or equivalent (eg, 0.5 g/kg every 2 hours)
>12 years: Refer to adult dosing.
Note: ~10 g of activated charcoal for each 1 g of toxin is considered adequate; this may require multiple doses. If sorbitol is also used, sorbitol dose should not exceed 1.5 g/kg. When using multiple doses of charcoal, sorbitol should be given with every other dose (not to exceed 2 doses/day).

DOSING: ELDERLY — Refer to adult dosing.

DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule:
Char-Caps, CharcoCaps®: 260 mg

Pellets, for suspension:
EZ-Char™ : 25 g

Powder for suspension: 30 g, 240 g
CharcoAid® G: 15 g

Suspension:
Actidose-Aqua®: 15 g (72 mL); 25 g (120 mL); 50 g (240 mL)
Kerr Insta-Char®: 25 g (120 mL) [contains sodium benzoate; packaged with cherry flavor (cherry flavor contains propylene glycol and sodium benzoate)]; 50 g (240 mL) [contains sodium benzoate; unflavored or packaged with cherry flavor (cherry flavor contains propylene glycol and sodium benzoate)]

Suspension [with sorbitol]:
Actidose® with Sorbitol: 25 g (120 mL); 50 g (240 mL)
Kerr Insta-Char®: 25 g (120 mL) [contains sodium benzoate; packaged with cherry flavor (cherry flavor contains propylene glycol and sodium benzoate)]; 50 g (240 mL) [contains sodium benzoate; packaged with cherry flavor (cherry flavor contains propylene glycol and sodium benzoate)]

Tablet:
Requa® Activated Charcoal: 250 mg

Tablet, enteric coated:
Charcoal Plus® DS: 250 mg

DOSAGE FORMS: CONCISE
Capsule:
Char-Caps [OTC], CharcoCaps® [OTC]: 260 mg

Pellets, for suspension:
EZ-Char™ [OTC]: 25 g

Powder for suspension: 30 g, 240 g
CharcoAid® G [OTC]: 15 g

Suspension:
Actidose-Aqua® [OTC]: 15 g, 25 g, 50 g
Kerr Insta-Char® [OTC]: 25 g, 50 g

Suspension [with sorbitol]:
Actidose® with Sorbitol [OTC], Kerr Insta-Char® [OTC]: 25 g, 50 g

Tablet:
Requa® Activated Charcoal [OTC]: 250 mg

Tablet, enteric coated:
Charcoal Plus® DS [OTC]: 250 mg

GENERIC EQUIVALENT AVAILABLE — Yes: Powder

ADMINISTRATION — Flavoring agents (eg, chocolate, concentrated fruit juice) or thickening agents (eg, bentonite, carboxymethylcellulose) can enhance charcoal's palatability. If treatment includes ipecac syrup, induce vomiting prior to administration of charcoal. Often given with a laxative or cathartic; check for presence of bowel sounds before administration. I.V. antiemetics may be required to reduce the risk of vomiting during multiple-dose therapy with charcoal.

USE — Emergency treatment in poisoning by drugs and chemicals; aids the elimination of certain drugs and improves decontamination of excessive ingestions of sustained-release products or in the presence of bezoars; repetitive doses have proven useful to enhance the elimination of certain drugs (eg, carbamazepine, dapsone, phenobarbital, quinine, or theophylline); repetitive doses for gastric dialysis in uremia to adsorb various waste products; dietary supplement (digestive aid)

ADVERSE REACTIONS SIGNIFICANT — Frequency not defined.

Endocrine & metabolic: Hypernatremia, hypokalemia, and hypermagnesemia may occur with coadministration of cathartics

Gastrointestinal: Vomiting (incidence may increase with sorbitol), diarrhea (with sorbitol), constipation, swelling of abdomen, bowel obstruction, appendicitis

Respiratory: Aspiration (both gastric contents and charcoal)

Miscellaneous: Fecal discoloration (black)

CONTRAINDICATIONS — Hypersensitivity to charcoal or any component of the formulation; intestinal obstruction; GI tract not anatomically intact; patients at risk of hemorrhage or GI perforation; patients with an unprotected airway (eg, CNS depression without intubation); if use would increase risk and severity of aspiration

WARNINGS / PRECAUTIONS
Concerns related to adverse effects: Vomiting: Charcoal may cause vomiting; avoid use in hydrocarbon and caustic ingestions.

Disease-related concerns: Decreased peristalsis: Use with caution in patients with decreased peristalsis.

Concurrent drug therapy issues: Ipecac: When using ipecac with charcoal, ensure ipecac-induced vomiting has ceased prior to administering charcoal. Cathartics (eg, sorbitol, mannitol, magnesium sulfate): Coadministration of a cathartic is not recommended secondary to lack of compelling evidence and the increased morbidity associated with their use. If charcoal is administered with a cathartic, avoid excessive fluid and electrolyte losses, especially in children <1 year of age.

Special populations: Pediatrics: Charcoal with sorbitol not recommended in children <1 year of age.

Dosage form specific issues: Propylene glycol: Commercial charcoal products may contain propylene glycol.

Other warnings/precautions: Appropriate use: Not effective for cyanide, mineral acids, caustic alkalis, organic solvents, iron, ethanol, methanol, or lithium poisoning Efficacy: Most effective when administered within 30-60 minutes of ingestion.

DRUG INTERACTIONS
Leflunomide: Charcoal, Activated may decrease serum concentrations of the active metabolite(s) of Leflunomide. Management: Unless using this combination to intentionally enhance leflunomide elimination, consider an alternative to charcoal when possible. Separating drug administration is not likely to be effective at avoiding this interaction. Risk D: Consider therapy modification

ETHANOL / NUTRITION / HERB INTERACTIONS — Food: Do not mix with milk, ice cream, sherbet, or marmalade (may reduce charcoal's effectiveness).

PREGNANCY RISK FACTOR — C (show table)

LACTATION — Does not enter breast milk/compatible

CANADIAN BRAND NAMES — Charcadole®; Charcadole® TFS; Charcadole®, Aqueous

INTERNATIONAL BRAND NAMES — Bekarbon (ID); Ca-R-Bon (TH); Carbo Medicinalis (PL); Carbomix (FR, SE); Carbon Natural (UY); Carbosorb (NZ); Carbosorb S (NZ); Carbosorb X (AU); Carbosorb XS (AU); Carbotural (MX); Charcodote (GB, HK, KP); Charcotrace (AU); Deltacarbon (TH); Mamograf (AR); Norit (IL); RCOL (IN); Ultracarbon (SG)

MECHANISM OF ACTION — Adsorbs toxic substances or irritants, thus inhibiting GI absorption; adsorbs intestinal gas; the addition of sorbitol results in hyperosmotic laxative action causing catharsis

PHARMACODYNAMICS / KINETICS — Excretion: Feces (as charcoal)

PATIENT INFORMATION — Charcoal causes the stools to turn black. Do not use prior to calling a poison control center or a prescriber