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Charcoal
Pronunciation
U.S. Brand Names
Generic Available
Synonyms
Pharmacological Index
Use
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Drug Interactions
Stability
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Dietary Considerations
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(CHAR kole)

U.S. Brand Names
Actidose-Aqua®[OTC]; Actidose® With Sorbitol [OTC]; CharcoAid®[OTC]; Charcocaps®[OTC]; Insta-Char®[OTC]; Liqui-Char®[OTC]

Generic Available

Yes


Synonyms
Activated Carbon; Activated Charcoal; Adsorbent Charcoal; Liquid Antidote; Medicinal Carbon; Medicinal Charcoal

Pharmacological Index

Antidiarrheal; Antidote; Antiflatulent


Use

Emergency treatment in poisoning by drugs and chemicals; repetitive doses for gastric dialysis in uremia to adsorb various waste products, and repetitive doses have proven useful to enhance the elimination of certain drugs (eg, theophylline, phenobarbital, and aspirin)


Pregnancy Risk Factor

C


Contraindications

Not effective for cyanide, mineral acids, caustic alkalis, organic solvents, iron, ethanol, methanol poisoning, lithium; do not use charcoal with sorbitol in patients with fructose intolerance; charcoal with sorbitol is not recommended in children <1 year.


Warnings/Precautions

When using ipecac with charcoal, induce vomiting with ipecac before administering activated charcoal since charcoal adsorbs ipecac syrup; charcoal may cause vomiting which is hazardous in petroleum distillate and caustic ingestions; if charcoal in sorbitol is administered, doses should be limited to prevent excessive fluid and electrolyte losses; do not mix charcoal with milk, ice cream, or sherbet


Adverse Reactions

>10%:

Gastrointestinal: Vomiting, diarrhea with sorbitol, constipation

Miscellaneous: Stools will turn black

<1%: Swelling of abdomen


Drug Interactions

Do not administer concomitantly with syrup of ipecac; do not mix with milk, ice cream, or sherbet


Stability

Adsorbs gases from air, store in closed container


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

Absorption: Not absorbed from GI tract

Metabolism: Not metabolized

Elimination: As charcoal in feces


Usual Dosage

Oral:

Charcoal with sorbitol: Single-dose:

Children 1-12 years: 1-2 g/kg/dose or 15-30 g or approximately 5-10 times the weight of the ingested poison; 1 g adsorbs 100-1000 mg of poison; the use of repeat oral charcoal with sorbitol doses is not recommended. In young children, sorbitol should be repeated no more than 1-2 times/day.

Adults: 30-100 g

Charcoal in water:

Single-dose:

Infants <1 year: 1 g/kg

Children 1-12 years: 15-30 g or 1-2 g/kg

Adults: 30-100 g or 1-2 g/kg

Multiple-dose:

Infants <1 year: 0.5 g/kg every 4-6 hours

Children 1-12 years: 20-60 g or 0.5-1 g/kg every 2-6 hours until clinical observations, serum drug concentration have returned to a subtherapeutic range, or charcoal stool apparent

Adults: 20-60 g or 0.5-1 g/kg every 2-6 hours

Gastric dialysis: Adults: 20-50 g every 6 hours for 1-2 days

Intestinal gas, diarrhea, GI distress: Adults: 520-975 mg after meals or at first sign of discomfort; repeat as needed to a maximum dose of 4.16 g/day


Dietary Considerations

Milk, ice cream, sherbet, or marmalade may reduce charcoal's effectiveness


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

No effects or complications reported


Patient Information

Charcoal will cause your stools to turn black. Do not self-administer as an antidote before calling the poison control center, hospital emergency room, or physician for instructions (charcoal is not the antidote for all poisons). Pregnancy precautions: Inform prescriber if you are pregnant.


Nursing Implications

Too concentrated of slurries may clog airway; often given with a laxative or cathartic; check for presence of bowel sounds before administration


Dosage Forms

Capsule (Charcocaps®): 260 mg

Liquid, activated:

Actidose-Aqua®: 12.5 g (60 mL); 25 g (120 mL)

Liqui-Char®: 12.5 g (60 mL); 15 g (75 mL); 25 g (120 mL); 30 g (120 mL); 50 g (240 mL)

SuperChar®: 30 g (240 mL)

Liquid, activated, with propylene glycol: 12.5 g (60 mL); 25 g (120 mL)

Liquid, activated, with sorbitol:

Actidose® With Sorbitol: 25 g (120 mL); 50 g (240 mL)

Charcoaid®: 30 g (150 mL)

SuperChar®: 30 g (240 mL)

Powder for suspension, activated:

15 g, 30 g, 40 g, 120 g, 240 g

SuperChar®: 30 g


References

Baltarowich L, Winslett S, Frade P, et al, "Determination of Insta-Char Container Residues After Prolonged Undisturbed Storage," J Toxicol Clin Toxicol, 1995, 33(5):493-4.

Bradberry SM and Vale JA, "Multiple-Dose Activated Charcoal: A Review of Relevant Clinical Studies," J Toxicol Clin Toxicol, 1995, 33(5):407-16.

Brubacher JR, Levine B, DeRoos F, et al, "Intestinal Pseudo-Obstruction in Severe Theophylline Toxicity Treated With Massive Doses of Activated Charcoal," J Toxicol Clin Toxicol, 1995, 33(5):523.

Chyka PA, "Multiple-Dose Activated Charcoal and Enhancement of Systemic Drug Clearance: Summary of Studies in Animals and Human Volunteers," J Toxicol Clin Toxicol, 1995, 33(5):399-405.

Clark RF, Crockett R, Williams SR, et al, "Evaluation of the Prehospital Use of Activated Charcoal in Acute Poisoning," J Toxicol Clin Toxicol, 1995, 33(5):491.

Cooney DO, " In vitro Adsorption of Phenobarbital, Chlorpheniramine Maleate, and Theophylline by Four Commercially Available Activated Charcoal Suspensions," J Toxicol Clin Toxicol, 1995, 33(3):213-7.

Cooney DO, "Evaluation of the U.S. Pharmacopeia Adsorption Tests for Activated Charcoal and Proposals for Changes," Vet Hum Toxicol, 1995, 37(4):371-7.

Farley TA, "Severe Hypernatremic Dehydration After Use of an Activated Charcoal-Sorbitol Suspension," J Pediatr, 1986, 109(4):719-22.

Huettner PC, Finkler NJ, and Welch WR, "Colouterine Fistula Complicating Diverticulitis: Charcoal Challenge Test Aids in Diagnosis," Obstet Gynecol, 1992, 80(3 (Pt 2)):550-2.

Kitamura K, Yamane T, Shimotsuma M, et al, "Activated-Carbon-Oriented Laparoscopic Colectomy," Lancet, 1995, 345(8965):1638-9.

MacFarland AF and Chyka PA, "Selection of Activated Charcoal Products for the Treatment of Poisonings," Ann Pharmacother, 1993, 27(3):358-61.

Mauro LS, Nawarskas JJ, and Mauro VF, "Misadventures With Activated Charcoal and Recommendations for Safe Use," Ann Pharmacother, 1994, 28(7-8):915-24.

Neuvonen PJ, "Clinical Pharmacokinetics of Oral Activated Charcoal in Acute Intoxications," Clin Pharmacokinet, 1982, 7(6):465-89.

Palatnick W and Tenebein M, "Activated Charcoal in the Treatment of Drug Overdose: An Update," Drug Saf, 1992, 7(1):3-7.

Perez P, Givonetti L, Potts K, et al, "Granisetron for the Prevention of Nausea and Vomiting in the Overdosed Patient," J Toxicol Clin Toxicol, 1995, 33(5):521.


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