Activated Charcoal

South African indications:

• Acute oral poisoning
• Drug overdose

Cautions

• Renal impairment
• Hepatic impairment
• Poisoning by strong acids, alkalis and other corrosive substances
• Poisoning by cyanide, iron salts and some solvents including methanol, ethanol and ethylene glycol
• Where toxicant has diuretic properties or has been ingested with alcohol
• Immediate endoscopy

Forms avail. in SA and covered in this monograph: pdr

Acute oral poisoning
Drug overdose

• Oral (pdr): 50g mixed with water as a suspension; repeat if necessary

Activated charcoal should be administered under medical supervision  

Activated charcoal should be given as soon as possible after the ingestion of the potential poison

The suspension is to be taken orally or given by intragastric tube using the applicator provided

Activated charcoal may be administered after emesis or gastric lavage and may be used concurrently with parenteral antidotes such as acetylcysteine

Activated charcoal should only be administered to unconscious patients who have a cuffed endotracheal tube in place to protect
the airway

Paed. forms avail in SA and covered in this monograph: pdr

Acute oral poisoning
Drug overdose

• Oral (pdr): 25-50g mixed with water as a suspension; repeat if necessary

Only if a large quantity of toxicant has been ingested, and where there is a risk to life, a dose of 50g is recommended

Activated charcoal should be administered under medical supervision  

Activated charcoal should be given as soon as possible after the ingestion of the potential poison

The suspension is to be taken orally or given by intragastric tube using the applicator provided

Activated charcoal may be administered after emesis or gastric lavage and may be used concurrently with parenteral antidotes such as acetylcysteine

Activated charcoal should only be administered to unconscious patients who have a cuffed endotracheal tube in place to protect
the airway

Pregnancy 

• Safe
• There is no evidence to suggest that activated charcoal should not be used during pregnancy. Activated charcoal is not systemically absorbed

Breastfeeding 

• Compatible 
• There is no evidence to suggest that activated charcoal should not be used during breastfeeding. Activated charcoal is not systemically absorbed

Renal Impairment 

• Caution; no information available

Hepatic Impairment

• Caution; no information available

Elderly

• No dose adjustment recommended

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

• Non-regulated product
• Non-regulated products are not subjected to rigorous controls to verify its efficacy, safety, nor that the ingredients, dosages and claims listed on the label are indeed accurate, therefore authorities caution athletes against the risk of using these products

Central Nervous System Disorders

• Headache (formulations with glycerol)

Respiratory Disorders

• Airway obstruction (on aspiration)

Gastrointestinal Disorders

• Black stools
• Bezoar formation
• Intestinal obstruction
• Constipation
• Diarrhoea
• Intestinal perforation
• Faecal impaction
• Upset stomach (formulations with glycerol)

• Systemically active oral emetics
• Oral antidotes
• Methionine

None routine

Considerations for use

• Activated charcoal adsorbs toxic substances and reduces or prevents systematic absorption. The shorter the time interval between ingestion of the toxicant and the administration of activated charcoal, the greater is the benefit for the patient
• However, as the absorption of massive drug overdoses is often retarded in acute conditions of intoxication, even the delayed administration of activated charcoal may be beneficial. In severe intoxication, repeated administration of activated charcoal s recommended to prevent absorbed drug being released (in an unbound state) in the lower intestinal tract or to expedite the elimination and prevent the re- absorption of any drug undergoing enterohepatic circulation

Use with ipecac syrup

• When ipecac syrup is used to induce emesis, it is recommended that activated charcoal be administered only after vomiting has been induced and completed, since ipecac syrup is adsorbed by the charcoal thus preventing emesis

Activated charcoal has adsorptive properties and is effective in reducing the absorption of a wide range of toxicants, including drugs taken in overdose. From the gut, there is evidence that the administration of activated charcoal can enhance the elimination of some compounds by creating an effective concentration gradient from the circulation to the gut.

Activated charcoal is available in several formulations. Please consult your pharmacy for the various products available.