Charcoal, Activated (Oral)

Activated charcoal is a medication that is used in the treatment of specific types or forms of poisoning, acting to prevent poison from absorption by the stomach.

Overview

Activated charcoal is used as a medication for emergency treatment in cases where the patient has consumed certain forms of poison. This medicine acts to prevent the stomach from absorbing the poison. More than one dose may be required for poisoning that is more severe.

This drug is only effective with certain forms of poison, and cannot be used for poisoning from corrosive agents, including alkalis or acid, as well as boric acid, iron, lithium or petroleum products such as coal oil, gasoline, paint thinner and cleaning fluid. Additionally, activation charcoal is not effective on alcohol that has been consumed, so will not help to prevent the poisons from then being absorbed.

In addition to the absorbent effects of activated charcoal, some medications may also contain Sorbitol. This medication is originally a sweetener that also acts as an effective laxative, and can cause severe diarrhea and vomiting. As such this combined medication is only given under supervision from a medical professional.

Activated charcoal can be purchased without a prescription. However, if this is being used as a preventative treatment for poisoning, it's essential that the patient contacts emergency medical help or poison control support for advice.

Conditions Treated

  • Poisoning

Type of Medicine

  • Charcoal
  • Liquid
  • Tablet (both swallow and chewable)
  • Suspension / Powder for Suspension

Side Effects

As well as the needed absorbent effects that are caused by activated charcoal, this medication may cause other side effects that can vary in levels of seriousness. The number of side effects experienced varies between patients depending on sensitivity, dosage and severity of poisoning.

Should any of the listed side effects happen after taking this medication, it is essential that the patient contacts their doctor as soon as possible. Some of the effects caused may require medical support.

The patient should contact emergency medical support if any of the side effects below occur after taking activated charcoal:

Swelling or pain in the stomach

As well as the side effects that require medical support, this medication can also cause side effects that are more expected, and less likely to cause harm. If the symptoms worsen, medical attention may be required.

If these side effects become uncomfortable or continue for a long time, the patient can get in contact with their doctor to discuss their options:

In addition to these side effects, it is also likely that taking activated charcoal will turn the patients' stools black. This is a harm-free side effect of the medication and is to be expected in almost every case.

As activated charcoal is given as an emergency treatment for poisoning, it's likely other side effects and symptoms related to the poisoning are also occurring. It's important to notify a medical professional of any side effects the patient is experiencing that are not related to activated charcoal, as this may mean the treatment is not working or more doses are required.

Many medications can cause an allergic reaction. If when taking activated charcoal, the patient experiences any signs of problems with breathing, swelling or hives, this can be a symptom of an allergic response. It's critical that the patient receives emergency medical attention as soon as they can, and it's important that the patient's doctor is aware of any and all allergies prior to using activated charcoal.

Dosage

Activated charcoal is available in multiple forms, including liquid, suspension and tablets. The dosage of medication prescribed can depend on several different factors, and it's important for the patient to follow their doctor's orders for the correct level of dosage for them.

The doses listed below represent an average amount for each category, and the advice of a medical professional should always be what is considered prior to taking any medications. Different forms of activated charcoal come in different levels of strength, and as such it is not advised to swap out one type for another without informing a medical professional.

For activated charcoal

For dosage orally (powder):

Treatment with single dose:

  • Adults/children above 12 - Between 25-100 grams mixed with water.
  • Children aged 1 to 12 years - Between 25-50 grams mixed with water, or based on weight of child. The recommended weight to dosage ratio is 0.5-1 g : 1kg (0.23-0.45 grams per pound), then mixed in water.
  • Children aged below 1 year - Dose between 10-25 grams mixed with water, or based on weight of child. The recommended weight to dosage ratio is 0.5-1 g: 1kg (0.23-0.45 grams per pound), then mixed in water.

Treatment with more than one dose:

  • Adults and children above 13 - Initial dose between 50 to 100 grams. Then this dose may be at 12.5 grams every hour, 25 grams every two hours, or 50 grams every four hours. Each dose will be mixed with water.
  • Children up to 13 years of age - Initial dose between 10 to 25 grams. Then the dose is calculated from body weight. Between 1 to 2 grams per kg (0.45 to 0.91 gram per pound) given every two to four hours is a usual dosage. Each dose will be mixed with water.

For dosage orally (oral suspension):

Treatment with single dose:

  • Adults/children above 12 - Between 25-100 grams.
    Children aged 1 to 12 years - Dose is usually 25-50 grams, or based on weight of child. It may be 0.5 to 1g : 1kg (0.23 to 0.45 grams per pound).
  • Children aged below 1 year - Dose is usually 10 to 25 grams, or the dose may be based on weight of child. The recommended weight to dosage ratio is 0.5 to 1 gram per kg (0.23 to 0.45 grams per pound) of weight.

Treatment with multiple doses:

  • Adults/children above 13 - Initial dose of 50-100 grams. This dose may be at 12.5 grams every hour, 25 grams every two hours, or 50 grams every four hours. Each dose will be mixed in water.
  • Children aged up to 13 years - Initial dose between 10 to 25 grams. Then the dose is calculated from body weight. Between 1 to 2 grams per kg (0.45 to 0.91 gram per pound) given every 2 to 4 hours is a usual dosage. Each dose will be mixed with water.

For sorbitol and activated charcoal

For oral dosage form (oral suspension):

  • Adults/children above 12 - Between 50-100 grams of activated charcoal given once
  • Children aged 1 through 12 years - Between 25-50 grams of activated charcoal given once
  • Children aged up to 1 year - Not recommended as a treatment method

Interaction

Many medications can cause interactions within the body, especially when taken with other medications. This can lead to differing effects of medicines, which in turn can cause more side effects. These side effects can potentially end in the medication becoming harmful to the patient or ineffective over time.

Both patients and their doctors should maintain a complete record of all drugs and over the counter medicines being used both regularly or recently, so that the doctor can help to prevent issues with drug interaction. This can allow the patient's medical practice to have a fully realized picture of the patient's medical history. This may influence the medical professional's decision to prescribe this drug as a suitable medication.

The following drugs can cause a severe interaction when taken with activated charcoal, and are not recommended to be taken together. If taken or prescribed together, it is critical for the patient to inform their healthcare professional:

  • Naltrexone

The below drugs may cause a moderate interaction when taken with activated charcoal, and it is recommended that the patient should get in contact with their doctor if already prescribed any of these medicines:

  • Zolpidem
  • Tramadol
  • Tiotropium
  • Tapentadol
  • Sufentanil
  • Remifentanil
  • Periciazine
  • Pentazocine
  • Oxymorphone
  • Oxycodone
  • Mycophenolic Acid
  • Mycophenolate Mofetil
  • Morphine Sulfate Liposome
  • Morphine
  • Methadone
  • Meperidine
  • Meclizine
  • Lorazepam
  • Hydrocodone
  • Flibanserin
  • Fentanyl
  • Doxylamine
  • Donepezil
  • Dihydrocodeine
  • Digoxin
  • Codeine
  • Carbinoxamine
  • Butorphanol
  • Bupropion
  • Buprenorphine
  • Bromopride
  • Bromazepam

Certain medications should generally not be taken around the same time as eating food, both in general or specific food types, as this may cause interactions. Using tobacco or alcohol with certain medications may also create interactions. Due to the nature of this medication's use for poisoning, it's important that the patient consults with their doctor for interactions with both activated charcoal and the substance that they were poisoned by.

When taking activated charcoal, it is important to not combine or mix this medication with these food types, as they may cause the medicine not to work efficiently:

  • Sherbet
  • Ice cream
  • Chocolate syrup

The presence of pre-existing or recent medical conditions may also affect the level of suitability of activated charcoal, or may result in other side effects that can cause risk to the patient. The patient's medical practice should always be fully informed of their health if they have any pre-existing medical problems, as certain types of medication, including activated charcoal, can make these illnesses either recurrent or worse:

  • Intestinal Bleeding
  • Intestinal Blockage
  • Hole in the intestine
  • Decreased awareness
  • Dehydration
  • Reduced or slow digestion
  • Recent surgery

Warnings

Before the patient and the doctor decide for the patient to take activated charcoal as a treatment, there are some things to be considered.

This medication is often prescribed as a method to treat certain types of poisoning. Therefore, it may also be recommended to call a poison control center or an emergency medical service for advice. Having these numbers available allows for swift response should activated charcoal not prove effective.

When taking a dosage of activated charcoal that is in powder form for suspension, to prevent activated charcoal powder from scattering, it's important to be careful when opening and adding water to the powder container. Loss of powder may result in a reduced dose, and if the patient is struggling with the powder it may be suggested that another form is used.

It is important when using activate charcoal in its liquid form that you shake the container of this medication well before taking it for at least a minute, as some of the charcoal may have settled in the bottom. It is important to ensure all the liquid is drunk for a correct dosage. Following this, the patient should rinse the container with a small amount of water, shake the container, and then drink this mixture to get the full dose of activated charcoal.

If the patient has been advised to take both this medicine and ipecac syrup, a medication that induces vomiting, to treat the poisoning, do not take activated charcoal until after you have taken the ipecac syrup to induce vomiting, and the vomiting has then stopped. This usually takes about 30 minutes. Taking activated charcoal during this time is likely to result in it then being expelled from the body, therefore being ineffective for treatment.

Activated charcoal is not known to cause any harm to pregnant women or unborn infants, and is not harmful to nursing children. It is advised that the patient should consult with a medical professional under these circumstances, or if the patient has plans to become pregnant.

If the patient is currently prescribed any other medication, it is important to not take it within 2 hours of activated charcoal. Taking other medications together with this drug may prevent the other medication from being absorbed within the body. If a dosage of activated charcoal is in the same time frame as doses of other medications, it is advised to contact a medical professional to decide the best way to move forward.

Storage

Activated charcoal should be stored in the medical container that it is dispensed in. All forms of this medication should be kept tightly closed, stored out of reach of children and pets. This medication should be kept from areas with excess moisture, variable heat and direct sunlight (such as bathrooms and kitchens), and kept safe and dry at all times.

Any unused medication should be disposed of appropriately if not longer required.

Summary

Activated charcoal is a form of medication used for the emergency treatment of certain types of poisoning. This medicine works to prevent the stomach from absorbing the poison, therefore reducing the effects of poisoning. More than one dose may be required for severe poisoning.

This medication is only valid for specific forms of poison, and cannot be used for poisoning from:

  • Corrosive agents
  • Boric acid
  • Iron
  • Lithium
  • Petroleum products such as coal oil, gasoline, paint thinner or cleaning fluid

This medication is also not sufficient for alcohol poisoning.

Activated charcoal is used as a medication for children below the age of 1 through to adults. It is available in a suspension form, a liquid form and a tablet form. It is considered safe for use during pregnancy, though some side effects may cause risk to an unborn child.

Some activated charcoal medications also contain Sorbitol. This acts as an effective laxative and can cause severe diarrhea and vomiting to remove poisons from the system as quickly as possible.

Activated charcoal can be bought without a prescription. However, if it is being used as a preventative treatment for active poisoning, it is essential that the patient gets in contact with emergency medical help or a poison control center for advice in order to get the most effective support.