VA Class:GA900
ATC Class:A07BA
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.
Activated charcoal is an adsorbent used in the treatment (i.e., GI decontamination)104 of most oral poisonings except those caused by corrosive agents (e.g., strong acids or alkalis) or substances for which its absorptive capacity is too low to be clinically useful (e.g., iron salts, lithium, boric acid, arsenic, malathion, or organic solvents such as methanol, ethanol, or ethylene glycol).101, 102, 103, 105, 106, 107, 108, 110, 112, 116 Randomized, controlled studies demonstrating the efficacy of GI decontamination measures, including activated charcoal, in reducing morbidity and mortality associated with most oral poisonings generally are lacking,101, 113 and an expert panel of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists (AACT/EAPCCT) states that activated charcoal should not be administered routinely in the management of poisoned patients.113 However, since beneficial effects of activated charcoal have not been ruled out and the risks of a single dose of activated charcoal appear to be low,101 many clinicians currently consider single-dose activated charcoal the sole intervention needed for the immediate treatment of most oral poisonings.101, 102, 103, 104, 105, 109, 110 Activated charcoal is the most commonly used agent for GI decontamination in poisoned patients; however, use of activated charcoal has declined from 7.7% of all exposures reported to US poison control centers in 1995 to 5.6% of such exposures in 2004.132 Although the American Academy of Pediatrics (AAP) and other experts no longer recommend the routine use of ipecac syrup for out-of-hospital management of poisonings (see Uses: Acute Poisoning, in Ipecac Syrup 56:20), they state that current evidence does not support the routine administration of activated charcoal in the home as an alternative since safety and efficacy have not been established.117
A few comparative studies in healthy individuals have shown that early GI decontamination with activated charcoal decreases absorption of ingested substances as well as or better than either induction of emesis or gastric lavage, and the combination of gastric emptying or ipecac plus activated charcoal generally does not appear to be more effective than activated charcoal alone.101, 103, 105, 108 In addition, available data do not support the routine use of cathartics in combination with activated charcoal to remove the toxin/charcoal complex.107, 108, 114, 129 Specialized references and experts should be consulted for additional information about the use of activated charcoal in the management of poisoning caused by specific agents.
Studies in healthy individuals suggest that activated charcoal may be beneficial if it is administered early (e.g., within 30-60 minutes of ingestion) in the management of acute poisoning102, 105, 107, 113 and that the effectiveness of activated charcoal decreases over time.113 Therefore, the AACT/EAPCCT state that administration of activated charcoal may be considered up to 1 hour after ingestion of a potentially toxic amount of a poison known to be adsorbed by activated charcoal.113 AACT/EAPCCT also state that, although results of studies in healthy individuals suggest that the reduction in drug absorption achieved when activated charcoal is administered more than 1 hour after poison ingestion is of questionable clinical importance, the potential for benefit from use of activated charcoal more than 1 hour after ingestion cannot be excluded.110, 113 Some clinicians suggest that administration of activated charcoal more than 1 hour following acute poisoning may be appropriate because of the difficulty in obtaining accurate histories regarding the time of ingestion of the toxic agent from pediatric or obtunded patients or suicidal individuals.110, 129 Late administration of activated charcoal may be beneficial if the ingested substance undergoes enterohepatic circulation and reabsorption because of charcoal's ability to promote efflux of selected drugs (e.g., theophylline, phenobarbital, carbamazepine) from the blood into the bowel lumen.102, 103, 104, 105, 107, 110 Some clinicians state that activated charcoal also may be of some benefit when given several hours after ingestion of extended-release drugs or drugs that slow gastric emptying,102, 107 although others have suggested that charcoal may not be effective in reducing absorption of extended-release preparations because of their prolonged dissolution.108
Although activated charcoal adsorbs some aliphatic hydrocarbons (e.g., gasoline, kerosene), its use is not recommended to treat ingestion of these substances (unless they also contain toxic additives) since they rarely produce toxicity other than that associated with aspiration.105, 107, 113, 129 Activated charcoal is unlikely to enhance elimination of agents that are rapidly absorbed (e.g., strychnine, cyanides).105 Although a quantity of potassium cyanide (1.75-2.1 g) equivalent to several potentially lethal (e.g., 200 mg) doses may be adsorbed by a 50- to 60-g dose of activated charcoal,113, 129 the adsorbent will not be useful in many ingestions of simple cyanide salts because of the rapid onset of life-threatening cyanide toxicity.113
While multiple-dose administration of activated charcoal is unlikely to be an important measure for most intoxications,103, 109 repeated doses of activated charcoal may enhance the elimination of some drugs even after systemic absorption (e.g., theophylline) by interrupting enterohepatic circulation or reducing reabsorption of drugs that diffuse or are excreted into the intestines.101, 102, 103, 104, 105, 107, 129 In animal studies, multiple doses of charcoal increased the total body clearance of acetaminophen, digoxin, phenobarbital, phenytoin, and theophylline.114 The use of multiple doses of activated charcoal may be considered for drugs that undergo enterohepatic or enteroenteric circulation, those with a small volume of distribution, those that are not extensively protein bound, and those with a low endogenous clearance.102, 104, 107 Multiple-dose activated charcoal also may be considered if a life-threatening amount of phenobarbital, carbamazepine, quinine, dapsone, theophylline, paraquat, or Amanita phalloides is ingested;103, 105, 110, 114 such treatment may obviate the need for more invasive interventions (e.g., extracorporeal techniques).114 Multiple-dose activated charcoal does not enhance the elimination of cyclic antidepressants, and its efficacy in the treatment of intoxication with digoxin, digitoxin, phenytoin, sodium valproate, meprobamate, dapsone, carbamazepine, or cyclosporine has not been fully elucidated.103
The “universal antidote” (2 parts activated charcoal, 1 part magnesium oxide, and 1 part tannic acid) is inferior to activated charcoal alone, and the tannic acid component is potentially hepatotoxic.102 Thus, there is no justification for the use of the “universal antidote.”102
Hemoperfusion through columns of activated charcoal is used to remove endogenous or exogenous toxins and has been performed in patients with uremia, hepatic failure, or acute toxicity caused by acetaminophen, barbiturates, glutethimide, methaqualone, methyprylon, or theophylline.102 Hemoperfusion through activated charcoal has been associated with substantial damage to formed blood elements including platelets, leukocytes, and erythrocytes (e.g., platelet aggregation, thrombocytopenia) and has been associated with the formation of free charcoal particle emboli. These hazards have been minimized by coating the activated charcoal with a biocompatible polymer such as poly (hydroxyethylmethacrylate).
Activated charcoal has been used to adsorb intestinal gases in the treatment of flatulence, intestinal distension, and dyspepsia;102 however, the US Food and Drug Administration (FDA) has classified activated charcoal as lacking substantial evidence of efficacy as an antiflatulent or digestive aid.107 Activated charcoal has been used alone or in combination with kaolin in the management of diarrhea but its value has not been established.
Activated charcoal also has been used topically in wound or ulcer dressings to decrease odor and promote healing.102
Activated charcoal has been used in the management of erythropoietic porphyria† (to interrupt the enterohepatic recycling of protoporphyrin and lower plasma porphyrin concentrations) and for symptomatic relief of pruritis in patients with renal failure†.102
Activated charcoal is administered orally107 or via nasogastric or orogastric tube.113, 129 Activated charcoal powder can be administered as an extemporaneously prepared aqueous slurry or suspension and is commercially available as a suspension.101, 102, 107
Activated charcoal is most effective when administered early in the management of acute poisoning, preferably within 30-60 minutes of ingestion of the poison,101, 102, 103, 104, 105, 113 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.102, 103, 105, 108 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).103 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,108, 118 most clinicians no longer recommend routine use of ipecac syrup in the emergency department or hospital setting.103, 105, 109, 117, 118, 119, 120 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.118 (See Uses: Acute Poisoning, in Ipecac Syrup 56:20.)103, 107 Although activated charcoal does not appear to diminish the emetic effects of ipecac syrup when given 10 minutes following the ipecac dose,103 vomiting should be completed before administration of activated charcoal.107 (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.102, 103, 106, 107 Therefore, sorbitol has been used in the extemporaneous preparation of activated charcoal suspensions and is found in some commercial preparations.102, 106, 107 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.102, 103, 105, 107, 110 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.103, 107 Also, if sorbitol is used with an initial dose of activated charcoal, a second cathartic generally should not be administered.107 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.107
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.104, 115 However, some clinicians state that flavoring agents have been shown to decrease the adsorptive capacity of activated charcoal and generally should not be used.107 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.102 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.102
If possible, individuals attempting to manage an acute poisoning in a medically unsupervised setting (e.g., at home) should attempt to contact a poison control center, emergency medical facility, or other qualified health professional.100 If such help cannot be obtained quickly, the directions on the container of activated charcoal should be followed.100 Because activated charcoal can adsorb ipecac syrup, individuals attempting to manage an acute poisoning in a medically unsupervised setting should not administer activated charcoal to a patient who has received ipecac syrup until after the patient has vomited unless otherwise directed by a health professional.100
The optimum dose of activated charcoal for the treatment of poisoning in adults and adolescents has not been established.113 For single-dose treatment, a dose of 25-100 g (e.g., 50 g) of activated charcoal, given as a slurry in water, has been recommended in adults or adolescents 13 years of age or older.102, 103, 104, 105, 107, 108, 110, 113 Some clinicians suggest a dose of 50-100 g in adults102, 103, 105, 108 and state that a large dose (i.e., 1 g/kg) is required to promote adsorption and prevent desorption of the ingested substance, 103 although others state that desorption of toxins from charcoal does not appear to be clinically important.104 Other clinicians state that a dose of 0.5-1 g /kg usually is appropriate,129 but that doses of 1.5-2 g/kg may be desirable for treatment of massive ingestions of highly toxic substances that are known to be well adsorbed by activated charcoal (e.g., aspirin, theophylline, extended-release verapamil) or when substantial clinical benefit may be provided by adsorption of a limited amount of a lethal substance (e.g., cyanide).129 Activated charcoal doses of up to 120 g reportedly have been well tolerated.
The usual dosage of activated charcoal for multiple-dose treatment in adults or adolescents 13 years of age or older is 50-100 g initially, followed by not less than 12.5 g every hour;114 alternatively, 25 g every 2 hours or 50 g every 4 hours may be given.102, 105, 107 Some clinicians recommend that 150-200 g of activated charcoal be administered in divided doses via a nasogastric tube over 4-8 hours in severely poisoned adults; the total dose administered may be more important than the frequency of administration.103 Other clinicians suggest a dosage of 0.5-1 g/kg administered every 4-6 hours for lower-risk ingestions and larger individual doses for more serious ingestions (e.g., administration of the highest dosage tolerated by the patient [e.g., 1-1.5 g/kg per hour] for life-threatening acute poisoning with extended-release theophylline).129 Higher dosages may be better tolerated by some patients when administered via continuous nasogastric infusion or when divided into smaller amounts and given more frequently.129 An antiemetic often is required to successfully administer high dosages of activated charcoal; however, because some antiemetics (e.g., phenothiazines) may decrease GI motility and lower the seizure threshold, use of a type 3 serotonin (5-HT3) receptor antagonist (e.g., ondansetron) or metoclopramide may be preferred.129 Multiple-dose therapy with activated charcoal generally should be continued until the patient recovers or until major symptoms of toxicity resolve.105, 107
The optimum dose of activated charcoal in the treatment of poisoning in pediatric patients has not been established.113 Some clinicians state that optimal adsorption appears to occur at a charcoal-to-toxin ratio of 10 to 1 or higher104, 108, 110 but that a fixed dose of 1 g/kg generally is recommended in children.104, 110 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.107, 113 Infants up to 1 year of age may receive 10-25 g or 0.5-1 g/kg.107, 110, 113 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.103 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.104
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.107 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.114 Multiple-dose therapy with activated charcoal generally should be continued until the patient recovers or until major symptoms of toxicity resolve.107, 114 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.114
In the management of GI disturbances such as flatulence or dyspepsia, activated charcoal has been administered in single doses of 0.6-5 g or in a dosage of 0.975-3.9 g 3 times daily after meals.
Activated charcoal is generally well tolerated when given orally, particularly as a single-dose treatment.101, 102, 108, 110, 113, 114, 129 However, potential risks associated with administration of the drug include vomiting, pulmonary aspiration (fatalities have been reported), and intestinal obstruction (with multiple-dose administration).101, 102, 103, 104, 108, 110, 113, 114
Adverse GI effects associated with the use of activated charcoal include vomiting,102 constipation,102 diarrhea,102 and GI obstruction102, 114 or fecal impaction102 in dehydrated patients;102, 103, 108, 114 constipation and intestinal obstruction have not been reported to occur with single-dose administration of activated charcoal.108, 113, 129 GI obstruction or pseudo-obstruction has been reported rarely with multiple-dose administration, generally when doses were administered at 3- to 6-hour intervals for 36-120 hours.129 At least one patient developed a rectal ulcer with massive hemorrhage following multiple-dose activated charcoal administration.114
Vomiting reportedly occurs in about 7-20% of patients following administration of activated charcoal.104, 113, 124, 125, 127, 128, 131 Although some data suggest that vomiting occurs more frequently when activated charcoal is administered with sorbitol,113, 124 other data suggest that sorbitol content does not substantially increase the risk for vomiting but rather that risk is increased in children with prior episodes of vomiting and in those receiving activated charcoal via nasogastric or orogastric tube administration.131
Activated charcoal may produce black stools.102, 107
Aspiration of activated charcoal has occurred rarely, and has resulted in granulomatous reactions, bronchiolitis obliterans, tissue reaction to suspension agents (sorbitol, povidone), and increased lung permeability.101, 102, 104, 110, 111, 114 In one study of patients following acute overdosage, aspiration of activated charcoal occurred in about 2% of patients receiving activated charcoal alone and about 2% of those undergoing gastric emptying followed by activated charcoal.101 In rare cases, activated charcoal has been inadvertently introduced into the lung by a misplaced nasogastric tube.101, 102, 104, 111, 114 Death resulting from aspiration of activated charcoal has been reported rarely.101, 104, 108, 110, 130
Transient corneal abrasions have occurred when activated charcoal came in direct contact with the eye during administration.113, 126
Precautions and Contraindications
Activated charcoal is not effective in adsorbing all drugs and toxic substances and its administration should not preclude other measures used in the emergency treatment of poisoning. In addition to a lack of evidence documenting the beneficial effects of activated charcoal following ingestion of corrosives or petroleum distillates, activated charcoal should not be used in the management of ingestion of these agents since vomiting may occur following its administration and charcoal may obscure endoscopic evaluation of gastroesophageal lesions.103, 107, 108 Activated charcoal only moderately adsorbs petroleum distillates (e.g., gasoline, kerosene),103 and the ingestion of these substances rarely result in toxicity other than that associated with aspiration (unless they also contain toxic additives).105, 107, 113 Although activated charcoal alone is not usually associated with an increased risk of aspiration,101 its administration may cause vomiting (e.g., because of concomitant water load and/or co-administration of sorbitol as a vehicle) and increase the potential for aspiration of gastric contents.101, 102, 103, 107, 113, 114 Measures should be taken to reduce the risk of aspiration (e.g., placement of a cuffed endotracheal tube in patients with impaired laryngeal reflexes)102, 107, 113 since aspiration of activated charcoal may lead to more severe complications than aspiration of gastric contents alone.101, 102 (See Cautions: Pulmonary Effects.) Sorbitol or other cathartics should not be administered with each dose of activated charcoal because of the potential for dehydration, hypotension and electrolyte disturbances (e.g., hypernatremia) associated with excessive catharsis.102, 103, 105, 129
Generally, activated charcoal should not be used when there is decreased peristalsis (i.e., reduced or absent bowel sounds); risk of GI obstruction, perforation or hemorrha recent surgery; electrolyte imbalance; or volume depletion.103, 107, 113 Activated charcoal is contraindicated prior to endoscopy, following ingestion of corrosive agents105 unless it is necessary to adsorb another ingested toxin.103, 107, 113 Administration of activated charcoal is contraindicated in patients with an unprotected airway, a GI tract that is not anatomically intact, and in poisonings in which the risk or severity of aspiration may be increased (e.g., hydrocarbon ingestions with a high aspiration potential).107, 113, 114 In addition, multiple-dose activated charcoal is contraindicated in the presence of ileus or bowel obstruction.103, 107, 114
In general, activated charcoal can decrease the absorption of and therapeutic response to other orally administered drugs.102, 106, 107 Medications other than those used for GI decontamination or antidotes for ingested toxins should not be taken orally within 2 hours of administration of activated charcoal; if necessary, concomitant drug therapy can be given parenterally.102, 107
Acetylcysteine may be administered orally concomitantly with activated charcoal without impairment of its efficacy.105, 107 Although acetylcysteine is adsorbed by activated charcoal in vitro,107 studies in humans indicate that efficacy of orally administered acetylcysteine is not substantially affected by the administration of activated charcoal.105, 107 Alternatively, IV administration of acetylcysteine obviates concerns about interactions between activated charcoal and orally administered acetylcysteine.113
The adsorptive efficacy of activated charcoal may be decreased by the emesis induced by ipecac syrup; if both are to be used in the management of oral poisoning, activated charcoal should be administered after vomiting has ceased.107 The emetic properties of ipecac are apparently not substantially affected by the administration of activated charcoal.103, 107, 113, 122 In some studies of healthy individuals, the emetic effects of ipecac syrup were not decreased when activated charcoal was administered within 10 minutes following administration of ipecac syrup, but prior to emesis.103, 107 However, activated charcoal has been reported to adsorb ipecac alkaloids,113, 121 and concurrent administration of activated charcoal and ipecac syrup is inconsistent with current practice.113 (See Dosage and Administration: Administration.)
Polyethylene Glycol and Electrolyte Solutions
The adsorptive capacity of activated charcoal may be decreased by concurrent use of polyethylene glycol and iso-osmolar electrolyte solution (PEG-ELS) for whole-bowel irrigation.107
The clinical use of activated charcoal is based on its adsorptive property. Activated charcoal is an effective, nonspecific adsorbent of a wide variety of drugs and chemicals and thus inhibits GI absorption of these agents. Activated charcoal has a broader spectrum of adsorptive activity than other adsorbents, including attapulgite, Arizona montmorillonite, or evaporated milk. Results of animal and limited human studies indicate that some of the adsorbed chemicals may be released from the charcoal in the GI tract, but this effect is not usually of clinical importance. The effectiveness of activated charcoal in the lower GI tract is questionable, since passage through the upper GI tract generally saturates the adsorptive capacity of the drug.
Activated charcoal also adsorbs enzymes, vitamins, amino acids, minerals, and other nutrients from the GI tract; however, this effect is of no importance when the drug is used in the management of acute poisoning.
Activated charcoal does not adequately adsorb alcohols (e.g., ethanol, methanol), ethylene glycol, iron salts, lithium, strong acids and alkalis, corrosive agents, boric acid, arsenic, malathion, or organic solvents for clinical use in GI decontamination with these ingestants.101, 105, 105 Although potassium cyanide equivalent to several potentially lethal doses may be adsorbed by 50-60 g of activated charcoal,113, 129 the rapid onset of life-threatening cyanide toxicity limits the usefulness of the adsorbent in many ingestions of simple cyanide salts.113 Burnt toast is not a form of activated charcoal and is not a useful antidote in the management of acute poisoning.
Activated charcoal is neither absorbed in the GI tract nor metabolized, and it is excreted in feces. Since it colors the feces black, activated charcoal can be used as a fecal marker.
Activated charcoal is the residue from the destructive distillation of various organic materials which has been treated to increase its adsorptive power.106, 108 Activated charcoal occurs as a fine, black, odorless, tasteless powder and is free from gritty matter.106, 108 To be an effective adsorbent, the particle size of activated charcoal must be small (thus increasing the total surface area) and the mineral content should be low.106 For medicinal purposes, only the “activated” grade of charcoal should be used, since it is specifically treated to increase its total surface area and adsorptive capacity. Although commercial varieties of activated charcoal may vary in adsorptive capacity, 1 g of the drug must adsorb at least 100 mg of strychnine sulfate from 50 mL of water to meet the USP standard.
Activated charcoal is insoluble in water and in alcohol.
Activated charcoal should be stored in well-closed glass or metal containers.
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Bulk | Powder* | |||
Extracorporeal | Hemoperfusion System | 150 g | Adsorba® 150 C Pediatric | |
300 g | Adsorba® 300 C | Gambro | ||
Oral | Capsules | 260 mg* | ||
For suspension | 15 g | CharcoAid® G | ||
Pellets | 25 g | |||
Suspension | 0.625 g/5 mL (15 or 25 g) | Paddock | ||
1 g/5 mL (15, 25, or 50 g) | Actidose-Aqua® | Paddock | ||
Actidose® with Sorbitol | Paddock | |||
Insta-Char® Adult | ||||
Insta-Char® Pediatric | Kerr | |||
Tablets, delayed-release (enteric-coated core) | 250 mg |
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Only references cited for selected revisions after 1984 are available electronically.
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