Charcoal Dosage

Usual Adult Dose for Gastrointestinal Decontamination

Activated Charcoal:
Single-dose: 25 to 100 g orally or by nasogastric tube once, as a slurry in water. The routine use of single-dose activated charcoal is not recommended.

Multiple-dose:
Initial dose: 50 to 100 g orally or by nasogastric tube, as a slurry in water
Maintenance dose: 12.5 g every hour, 25 g every 2 hours, or 50 g every 4 hours until symptoms resolve.

Usual Adult Dose for Flatulence

Capsules and tablets: 500 to 1040 mg up to 4 times daily as needed. Not effective in the treatment of poisoning.

Usual Pediatric Dose for Gastrointestinal Decontamination

Activated Charcoal:
Administer aqueous suspension or as a slurry in water.
Single dose:
<1 year: 0.5 to 1 g/kg or 10 to 25 g orally or by nasogastric tube once
1-12 years: 0.5 to 1 g/kg or 25 to 50 g orally or by nasogastric tube once
13-18 years: Single-dose: 25 to 100 g orally or by nasogastric tube once
The routine use of single-dose activated charcoal is not recommended.

Multiple-dose:
<13 years: Initial dose: 10 to 25 g orally or by nasogastric tube, as a slurry in water
Maintenance dose: 1 to 2 g/kg every 2 to 4 hours
13-18 years: Initial dose: 50 to 100 g orally or by nasogastric tube, as a slurry in water
Maintenance dose: 12.5 g every hour, 25 g every 2 hours, or 50 g every 4 hours until toxic symptoms resolve.

Usual Pediatric Dose for Flatulence

3 to 18 years:
Capsules and tablets: 500 to 1040 mg up to 4 times daily as needed. Not effective in the treatment of poisoning.

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

No adjustment recommended

Precautions

The routine use of single-dose activated charcoal for the management of poisoning is not recommended.

Administration is contraindicated in the presence of an unprotected airway, in patients with or at risk of gastrointestinal hemorrhage, perforation, or obstruction, or if administration would increase the risk of aspiration (i.e., hydrocarbon ingestion).

Caution is recommended in patients with poor gastrointestinal motility.

Should not be used in the management of acute corrosive or petroleum distillate ingestion since vomiting can occur following charcoal administration. Charcoal may also obscure the endoscopic evaluation of gastroesophageal lesions.

May be administered in an attempt to adsorb any ingested toxic agent (where physical or other contraindications are not present), but it is known to be much less effective in the adsorption of boric acid, cadmium, cyanide, DDT, ethanol, ethylene glycol, iron, lead, lithium, mercury, methanol, potassium chloride, selenium, strong acid or alkali (may obscure lesion on endoscopy), and organic solvents.

Minimum dilution: 240 mL water per 20 to 30 g charcoal.

Milk, chocolate syrup, ice cream, and sherbet should not be mixed with charcoal because they may reduce its efficacy.

Activated charcoal may adsorb therapeutic agents while it remains in the GI tract. Dosages or route of administration of therapeutic drugs may need to be altered.

Charcoal tablets and capsules are ineffective for the treatment of poisoning due to inferior adsorptive capacity.

Dialysis

No adjustment recommended

Other Comments

For gastrointestinal decontamination, time since ingestion is a critical criterion in the decision to use charcoal for decontamination purposes. Typically, the recommended cutoff point for administration of charcoal for gastrointestinal decontamination is 1 to 2 hours post- ingestion. However, in cases where the ingested agent has anticholinergic activity (e.g., tricyclic antidepressants) or can slow the rate of gastric emptying by another mechanism (e.g., pentazocine, meperidine) then use of charcoal beyond 2 hours may still be beneficial.