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Charcoal, Activated (Monograph)

Brand names: Actidose, Adsorba, CharcoAid G, Charcoal Plus DS, CharcoCaps, ... show all 8 brands
Drug class: Antacids and Adsorbents
VA class: GA900
CAS number: 16291-96-6

Medically reviewed by on Aug 15, 2023. Written by ASHP.


Adsorbent and antidote; destructive distillation residue of organic materials with small particle size, treated to increase adsorptive power.

Uses for Charcoal, Activated


May be used for treatment (GI decontamination) in most oral poisonings except those involving corrosive agents (e.g., strong acids or alkalis) or substances for which its absorptive capacity is too low to be clinically useful (e.g., iron salts, lithium, boric acid, arsenic, malathion, or organic solvents such as methanol, ethanol, or ethylene glycol).

Most commonly used agent for GI decontamination in poisoned patients; however, routine administration in poisoned patients is not recommended by American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists (AACT/EAPCCT). Controlled studies demonstrating reduced morbidity and mortality generally are lacking. (See General: Poisonings, under Dosage and Administration.)


Hemoperfusion through columns of activated charcoal to remove endogenous or exogenous toxins in uremia, hepatic failure, or acute toxicity associated with overdose of certain drugs.

GI Disorders

Adsorption of intestinal gases in the treatment of flatulence, intestinal distention, and dyspepsia; FDA classified as lacking substantial evidence of efficacy as antiflatulent or digestive aid.

Has been used alone or combined with kaolin in the management of diarrhea, but value has not been established.

Wounds and Ulcers

Has been used in dressings for suppurating wounds or ulcers to decrease odor and promote healing.

Charcoal, Activated Dosage and Administration




Oral Administration

Administer activated charcoal powder orally or via nasogastric or orogastric tube as extemporaneously prepared slurry or suspension or commercially available suspension.

Continuous nasogastric infusion or division of the total dose into smaller amounts given more frequently may improve tolerance of large doses.

If an antiemetic is required to successfully administer high dosages, a serotonin type 3 ( 5-HT3) receptor antagonist (e.g., ondansetron) or metoclopramide may be preferred.

Sorbitol may be administered with single-dose activated charcoal or with first dose of multiple-dose regimen for palatability and laxative action; additional suspending and flavoring agents generally not recommended.


Extemporaneously, mix powder with sufficient tap water (e.g., 20–30 g in at least 240 mL) to form a slurry.


Pediatric Patients

Single-Dose or Multiple-Dose Regimens for Treatment of Poisoning in Children


Single Dose

Multiple Doses

Infants up to 1 year of age

10–25 g or 0.5–1 g/kg

Children up to 13 years of age

25–50 g or 0.5–1 g/kg

10–25 g initially, then 1–2 g/kg every 2–4 hours

Adolescents ≥13 years of age

25–100 g

50–100 g initially, then 12.5 g every hour, 25 g every 2 hours, or 50 g every 4 hours



Single dose: 25–100 g or 0.5–1 g /kg; for massive ingestion of a highly toxic substance or if limited adsorption of a lethal substance may provide substantial clinical benefit, 1.5–2 g/kg may be given.

Multiple doses: 50–100 g, then 12.5 g every hour, 25 g every 2 hours, or 50 g every 4 hours. Alternatively, 0.5–1 g/kg every 4–6 hours for lower-risk ingestions and larger doses (e.g., 1–1.5 g/kg per hour) for more serious ingestions (e.g., life-threatening ingestion of extended-release theophylline). Continue multiple-dose therapy until patient recovers or major toxicity resolves.

GI Disorders

0.6–5 g as a single dose or 0.975–3.9 g 3 times daily after meals.

Cautions for Charcoal, Activated




Petroleum Distillates Ingestion

Do not use for ingestion of petroleum distillates (e.g., gasoline, kerosene); limited efficacy, and toxicity other than aspiration is rare.

Sorbitol and Cathartics

Sorbitol, present in many commercial preparations, should be administered only with a single dose of activated charcoal or the first dose of multiple-dose activated charcoal; no more than 1 or 2 doses of sorbitol or another cathartic (if required) should be used in a 24-hour period because of potential for dehydration, hypotension, electrolyte disturbances (e.g., hypernatremia) associated with excessive catharsis.

If sorbitol is used with an initial dose of activated charcoal, a second cathartic generally should not be administered.

Use sorbitol with caution in children and geriatric patients; monitor hydration and electrolytes.

General Precautions

GI Effects

May cause vomiting, constipation, diarrhea, and GI obstruction or fecal impaction in dehydrated patients.

Generally should not be used when decreased peristalsis present (reduced or absent bowel sounds); if risk of GI obstruction, perforation, or hemorrhage exists; if surgery has occurred recently; or if electrolyte imbalance or volume depletion exists.

Pulmonary Effects

Aspiration of activated charcoal may lead to more severe complications than aspiration of gastric contents alone. Aspiration from vomiting or misdirected nasogastric catheter has resulted in granulomatous reactions, bronchiolitis obliterans, tissue reaction to suspension agents (sorbitol, povidone), increased lung permeability, and rarely, death.

Take measures to reduce the risk of aspiration (e.g., placement of a cuffed endotracheal tube in patients with impaired laryngeal reflexes).

Use of Fixed Combination

When used in fixed combination with other agents, consider the cautions, precautions, and contraindications associated with the concomitant agents.

Common Adverse Effects

Vomiting, diarrhea, constipation, black stools.

Drug Interactions

May decrease absorption of and therapeutic response to other orally administered drugs. Drugs other than those used for GI decontamination or antidotes for ingested toxins should not be given within 2 hours of activated charcoal; if necessary, concomitant drug therapy can be given parenterally.

Specific Drugs




Acetylcysteine, oral

Adsorption of acetylcysteine in vitro; no substantial decrease in efficacy apparent in human studies

Ipecac syrup

Ipecac-induced emesis may interfere with adsorptive efficacy of activated charcoal; decreased emesis with ipecac unlikely

Ipecac not generally recommended; if ipecac has been used to induce emesis, administer activated charcoal after vomiting has ceased

Polyethylene glycol and electrolyte solutions

Potential decreased adsorptive capacity of activated charcoal

Charcoal, Activated Pharmacokinetics



Not absorbed from the GI tract.



Does not undergo metabolism.

Elimination Route

Excreted in feces.




Well-closed glass or metal containers.


Advice to Patients


Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

Activated Charcoal


Dosage Forms


Brand Names



Hemoperfusion System

150 g

Adsorba 150 C Pediatric


300 g

Adsorba 300 C




260 mg

Charcoal Activated Capsules




For suspension

15 g

CharcoAid G

Little Remedies


25 g




0.625 g/5 mL (15 or 25 g)

Actidose-Aqua (in aqueous solution)


1 g/5 mL (15, 25, or 50 g)

Actidose-Aqua (in aqueous solution)


Actidose with Sorbitol (in sorbitol solution)


Insta-Char Adult (in aqueous or sorbitol solution; cherry- or original-flavor)


Insta-Char Pediatric (in aqueous or sorbitol solution; cherry-flavor)


Liqui-Char (in aqueous solution)


Tablets, delayed-release (enteric-coated core)

250 mg

Charcoal Plus DS


Activated Charcoal Combinations


Dosage Forms


Brand Names



Tablets, delayed-release (enteric-coated core)

250 mg with Simethicone 80 mg



250 mg with Simethicone 125 mg

Flatulex Maximum Strength


AHFS DI Essentials™. © Copyright 2024, Selected Revisions August 25, 2016. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

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