Charcoal Plus DS Side Effects

Generic Name: charcoal

Note: This page contains information about the side effects of charcoal. Some of the dosage forms included on this document may not apply to the brand name Charcoal Plus DS.

Not all side effects for Charcoal Plus DS may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to charcoal: capsules, tablets

Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; diarrhea; temporary darkening of the stool; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur while taking charcoal (the active ingredient contained in Charcoal Plus DS)

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue).

For Healthcare Professionals

Applies to charcoal: compounding powder, oral capsule, oral delayed release tablet, oral granule for reconstitution, oral powder for reconstitution, oral suspension, oral tablet

Gastrointestinal

Gastrointestinal side effects have frequently included nausea and vomiting (13% to 30%) and constipation. Bowel obstruction, ileus, chalk like taste, perforation of the gastrointestinal tract and subsequent charcoal (the active ingredient contained in Charcoal Plus DS) peritoneum, and black colored stools have also been reported.[Ref]

A young woman developed a surgically acute abdomen following orogastric lavage and charcoal administration. Laparotomy revealed charcoal throughout the peritoneum. Complications included peritonitis, adhesions, abscess formation, persistent peritoneal charcoal deposits, oophorectomy, and small bowel resection.

A case report has described charcoal bezoar and small bowel obstruction following administration of 30 to 60 g of activated charcoal via nasogastric tube every 4 to 6 hours for 5 days.

In a study of 275 patients, 18 years old or younger, 20.4% (56/275) experienced vomiting within < 1 to 120 minutes (mean of 10 minutes) following enteral administration of 1 g/kg (no more than 50 g) of activated charcoal for acute poison ingestion. The following risk factors for vomiting were identified: nausea, a vomiting occurrence prior to charcoal ingestion, presence of signs or symptoms of poisoning (exclusive of nausea &/or vomiting), age greater than 12 years, administration by nasogastric or orogastric tube, and ingestion of emetogenic drug or chemical.

Bowel obstruction and ileus have occurred with multiple-dose administration.

Although charcoal is tasteless, it adheres to the surfaces of the mouth and tongue, producing a chalk like taste that can be unpalatable.[Ref]

Metabolic

Metabolic side effects have included hypernatremia, hypermagnesemia. electrolyte abnormalities, dehydration, and shock.[Ref]

Metabolic side effects occur primarily when sorbitol is combined with charcoal. Multiple-dose activated charcoal has been associated with hypernatremia and hypermagnesemia.[Ref]

Respiratory

Respiratory side effects have included bronchiolitis obliterans, empyema, and Adult Respiratory Distress Syndrome.[Ref]

Bronchiolitis obliterans and empyema have occurred due to charcoal aspiration following emesis.

Accidental administration of charcoal directly into the lungs has resulted in Adult Respiratory Distress Syndrome.[Ref]

Ocular

Ocular side effects have included corneal abrasions.[Ref]

Corneal abrasions may occur if charcoal comes in contact with eyes.[Ref]

Hematologic

Exacerbation of variegate porphyria may lead to increases in skin lesions, and urine and plasma porphyrins.[Ref]

Hematologic side effects have included exacerbation of variegate porphyria.[Ref]

References

1. Atkinson SW, Young Y, Trotter GA "Treatment with activated charcoal complicated by gastrointestinal obstruction requiring surgery." BMJ 305 (1992): 563

2. Neuvonen PJ "Clinical pharmacokinetics of oral activated charcoal in acute intoxications." Clin Pharmacokinet 7 (1982): 465-89

3. Daniel V "Fatal pulmonary aspiration of oral activate charcoal." BMJ 297 (1988): 684

4. Watson WA "Comment: misadventures with activated charcoal." Ann Pharmacother 29 (1995): 84-5

5. Mariani PJ, Pook N "Gastrointestinal tract perforation with charcoal peritoneum complicating orogastric intubation and lavage." Ann Emerg Med 22 (1993): 606-9

6. Herrington AM, Clifton GD "Toxicology and management of acute drug ingestions in adults." Pharmacotherapy 15 (1995): 182-200

7. Osterhoudt KC, Durbin D, Alpern ER, Henretig FM "Risk factors for emesis after therapeutic use of activated charcoal in acutely poisoned children." Pediatrics 113 (2004): 806-10

8. Mauro LS, Nawarskas JJ, Mauro VF "Misadventures with activated charcoal and recommendations for safe use." Ann Pharmacother 28 (1994): 915-24

9. McLuckie A, Forbes AM, Ilett KF "Role of repeated doses of oral activated charcoal in the treatment of acute intoxications." Anaesth Intensive Care 18 (1990): 375-84

10. Lopes de Freitas JM, Ferreira MG, Brito MJ "Charcoal deposits in the esophageal and gastric mucosa." Am J Gastroenterol 92 (1997): 1359-60

11. Watson WA, Cremer KF, Chapman JA "Gastrointestinal obstruction associated with multiple-dose activated charcoal." J Emerg Med 4 (1986): 401-7

12. Spyker DA, Minocha A "Toxicodynamic approach to management of the poisoned patient." J Emerg Med 6 (1988): 117-20

13. Ray MJ, Radin DR, Condie JD, Halls JM, Padin DR "Charcoal bezoar. Small-bowel obstruction secondary to amitriptyline overdose therapy [published erratum appears in Dig Dis Sci 1988 Oct;33(10):1344]." Dig Dis Sci 33 (1988): 106-7

14. Orisakwe OE "Activated charcoal: is failure to use it negligence or ignorance?" South Med J 87 (1994): 165-8

15. Friedman EA, Saltzman MJ, Delano BG, Beyer MM "Reduction in hyperlipidemia in hemodialysis patients treated with charcoal and oxidized starch (oxystarch)." Am J Clin Nutr 31 (1978): 1903-14

16. Dorrington CL, Johnson DW, Brant R "The frequency of complications associated with the use of multiple-dose activated charcoal." Ann Emerg Med 41 (2003): 370-7

17. Allerton JP, Strom JA "Hypernatremia due to repeated doses of charcoal-sorbitol." Am J Kidney Dis 17 (1991): 581-4

18. Harris CR, Filandrinos D "Accidental administration of activated charcoal into the lung: aspiration by proxy." Ann Emerg Med 22 (1993): 1470-3

19. Moll J, Kerns W 2nd, Tomaszewski C, Rose R "Incidence of aspiration pneumonia in intubated patients receiving activated charcoal." J Emerg Med 17 (1999): 279-83

20. Menzies DG, Busuttil A, Prescott LF "Fatal pulmonary aspiration of oral activated charcoal." BMJ 297 (1988): 459-60

21. Harsch HH "Aspiration of activated charcoal." N Engl J Med 314 (1986): 318

22. Pollack MM, Dunbar BS, Holbrook PR, Fields AI "Aspiration of activated charcoal and gastric contents." Ann Emerg Med 10 (1981): 528-9

23. Elliott CG, Colby TV, Kelly TM, Hicks HG "Charcoal lung. Bronchiolitis obliterans after aspiration of activated charcoal." Chest 96 (1989): 672-4

24. Justiniani FR, Hippalgaonkar R, Martinez LO "Charcoal-containing empyema complicating treatment for overdose." Chest 87 (1985): 404-5

25. Tomaszewski C "Activated charcoal--treatment or toxin? [comment]." J Toxicol Clin Toxicol 37 (1999): 17-8

26. The American Academy of Clinical Toxicology "Position statements: single-dose activated charcoal Available from: URL: http://www.clintox.org/Pos_Statements/Charcoal.html." ([2002 May 23]):

27. Hift RJ, Todd G, Meissner PN, Kirsch RE "Administration of oral activated charcoal in variegate porphyria results in a paradoxical clinical and biochemical deterioration." Br J Dermatol 149 (2003): 1266-9

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