activated charcoal

Absorption: None.

Distribution: None.

Metabolism/Excretion: Excreted unchanged in the feces.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(antidote)

ROUTE	ONSET	PEAK	DURATION
PO	within min	unknown	4–12 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

None.

Use Cautiously in:

Poisonings due to cyanide, corrosives, ethanol, methanol, petroleum distillates, organic solvents, mineral acids, or iron;
Endoscopic examination (observation will be obscured).

Adv. Reactions/Side Effects ⬆ ⬇

GI: black stools, constipation, diarrhea, vomiting

Interactions ⬆ ⬇

Drug-drug:

Other drugs, including laxatives, will be adsorbed by charcoal and as a result will not be systemically absorbed from the GI tract.

Drug-Food:

Milk, ice cream, or sherbet will ↓ ability of charcoal to absorb other agents.

Route/Dosage ⬆ ⬇

Antidote

PO (Adults ): 25–100 g (may be repeated every 4–6 hr).
PO (Children 1–12 yr): 25–50 g (may be repeated every 4–6 hr).
PO (Children <1 yr): 1 g/kg (may be repeated every 4–6 hr).

Availability ⬆ ⬇

(Generic available)

Oral solution: 15 g/72 mL^OTC; 25 g/120 mL^OTC; 25 g/240 mL^OTC; 50 g/250 mL^OTC
Oral suspension: 25 g/240 mL^OTC
In combination with:
sorbitol (Actidose with Sorbitol; Char-Flo with Sorbitol; Insta-Char/Sorbitol)

Assessment ⬆ ⬇

Assess neurologic status; administer only if patient is alert (unless airway is protected).
Inquire as to the type of drug or poison and time of ingestion.
Consult reference, poison control center, or provider for symptoms of toxicity of ingested agent(s).
Monitor BP, HR, respiratory and neurologic status, and urine output as indicated by toxicity of agent(s). Notify provider if symptoms persist or worsen.

Lab Test Considerations:

Chronic use may impair absorption of essential nutrients. This may result in ↓ mineral or electrolyte levels.

Implementation ⬆ ⬇

Treatment of Poisoning: Activated charcoal is most effective if administered ≤ 30 min of ingestion of drug or poison. Dosage may be repeated for drugs subjected to enterohepatic elimination to minimize further absorption.
PO: Mix each 20–30 g of activated charcoal with 240 mL water; administer as a slurry (unless using suspension with or without sorbitol). Do not administer with milk products (milk, ice cream, or sherbet). Encourage patient to drink additional water as tolerated. May need to be diluted with additional water to be thin enough to administer through a nasogastric tube.
- Shake oral suspension well before administration.
- Rapid ingestion may cause vomiting. If vomiting occurs shortly after administering dose, confer with provider about repeating dose.
- Do not administer other oral drugs for 2 hr before or after administering activated charcoal.
- Slurry is constipating; provider may order a laxative to speed removal of the drug. May not be required with products containing sorbitol.

Patient/Family Teaching ⬆ ⬇

Explain the purpose and side effects of activated charcoal. Inform patient that stools will turn black.
Poisoning: When counseling, discuss methods of prevention, need to confer with poison control center, health care provider, or emergency department before administering, and need to bring ingested substance to emergency department for identification.

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Classifications ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇