Activated charcoal

Charcoal activated Should be taken on an empty stomach. Recommendations on preparation techniques are product-specific. Consult product literature for specific instructions.

Powder/granules for oral susp: Mix with approx 350 mL of water, then shake vigorously to prepare a slurry. Oral susp and reconstituted powder/granules for susp may be mixed with soft drinks (e.g. caffeine-free diet cola) or fruit juices to improve palatability. Reconstitution instructions may vary among available products (refer to specific product guidelines).

Unprotected airway (e.g. CNS depression without intubation), gastrointestinal tract that is not anatomically intact, gastrointestinal haemorrhage or perforation; ileus or bowel obstruction (particularly in multiple-dose treatment); poisoning in which the risk or severity of aspiration may be enhanced (e.g. hydrocarbon ingestions with a high aspiration potential). Contraindications may vary among individual products (refer to specific product labelling for detailed information).

Patient with decreased peristalsis (e.g. reduced or absent bowel sounds); risk factors of gastrointestinal obstruction, perforation or haemorrhage; electrolyte imbalance, volume depletion, recent surgery, absent or impaired gag reflex; exposure to toxins which interfere with gastrointestinal motility (e.g. anticholinergics, opioids). Patients who are drowsy or comatose. Administer activated charcoal as soon as possible (preferably within 1 hour) after ingestion. When inducing vomiting using ipecac syrup, administer activated charcoal after vomiting has been completed. Limit administration with cathartics (e.g. sorbitol, Mg sulfate, mannitol) to a single dose, if necessary, to prevent fluid and electrolyte loss. Not effective or with limited value in the treatment of poisoning due to ingestion of low molecular weight compounds (e.g. cyanide, ethanol, Fe salts, lithium, methanol), petroleum distillates, ethylene glycol, malathion, arsenic, or boric acid. Not recommended in patients who have ingested strong acids, alkalis, or other corrosive substances; activated charcoal may obscure endoscopic evaluation of gastro-oesophageal lesions caused by the toxin. Cap/tab: Not recommended for use in the treatment of acute oral poisoning. Concurrent administration with oral emetics or oral antidotes (e.g. methionine). Children. Pregnancy and lactation.

Significant: Gastrointestinal effects, including vomiting (especially when administered with sorbitol), constipation, and diarrhoea; gastrointestinal obstruction or faecal impaction (particularly with multiple-dose treatment or in dehydrated patients), bezoar formation. Rarely, intestinal perforation or ulceration (particularly with multiple-dose treatment).
Eye disorders: Transient corneal abrasion (if with direct contact).
Gastrointestinal disorders: Black stools, black dental and mouth discolouration (temporary), abdominal distention.
Potentially Fatal: Rarely, pulmonary aspiration (which may produce airway obstruction).

Monitor for active bowel sounds before administration and during treatment (particularly in multiple-dose therapy).

Emesis induced by ipecac syrup may reduce the adsorptive efficacy of activated charcoal. May decrease the therapeutic effect of methionine due to adsorption. May interfere with the absorption of other oral drugs (including antibiotics) when used concomitantly.

Decreased adsorptive and therapeutic effect with certain foods used for flavouring (e.g. marmalade, milk, ice cream, sherbet, cocoa).

Description:
Mechanism of Action: Activated charcoal, the residue from the destructive distillation of different organic materials, is an antidote and a nonspecific adsorbent. It adsorbs toxic substances, thereby preventing gastrointestinal absorption and limiting or inhibiting systemic toxicity. In addition, multiple doses of activated charcoal may also adsorb any remaining unabsorbed drug in the gastrointestinal tract and interrupt some drugs' enteroenteric, enterogastric, and enterohepatic circulation.
Synonym(s): Decolorising carbon; medicinal charcoal; decolorising charcoal.
Pharmacokinetics:
Absorption: Not absorbed from the gastrointestinal tract.
Metabolism: Not metabolised.
Excretion: Via faeces (as charcoal).

Oral susp: Store between 20-25°C. Do not refrigerate. Tab or granules/powder for susp: Store below 25°C. Protect from moisture. Cap: Store between 15-30°C. Protect from light and moisture. Storage recommendations may vary between countries and among individual products (refer to specific product or local guidelines).

Antidotes & Detoxifying Agents / GIT Regulators, Antiflatulents & Anti-Inflammatories

A07BA01 - medicinal charcoal ; Belongs to the class of charcoal preparations. Used as intestinal adsorbents.

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Carbomix 50 g Granules for Oral Suspension (Beacon Pharmaceuticals Limited). MHRA. https://products.mhra.gov.uk. Accessed 21/01/2025.

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Charcodote (Teva UK Limited). MHRA. https://products.mhra.gov.uk. Accessed 21/01/2025.

Humco Charcoal Activated Powder (Humco Holding Group. Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 21/01/2025.

JL Braggs Medicinal Charcoal Tablets (JL Bragg [Ipswich] Limited). MHRA. https://products.mhra.gov.uk. Accessed 21/01/2025.

Joint Formulary Committee. Charcoal, Activated. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 21/01/2025.

Norit Capsule 200 mg (Rx Pharma Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 21/01/2025.

Norit Carbomix Granules 5 g in 6.15 g (Rx Pharma Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 21/01/2025.

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Ultracarbon N.F. Tablets (Antah Pharma Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 21/01/2025.