Charcoal
Medically reviewed by Drugs.com. Last updated on Sep 21, 2020.
Common Name(s): Activated charcoal, Animal charcoal, Charcoal, Gas black, Lamp black, Oral charcoal adsorbent
Clinical Overview
Use
Activated charcoal's main use is as an antidote in poisoning. It is promoted for use as an antiflatulent and in dyslipidemia, and has demonstrated benefit in wound healing, kidney disease, and diarrhea; however, clinical studies to support these uses are lacking.
Dosing
Acute poisoning antidote: In the management of poisonings, refer to local protocols. The recommended dosing of activated charcoal is as follows:
Children 1 year and younger: 10 to 25 g, or 0.5 to 1 g/kg.
Children 1 to 12 years: 25 to 50 g, or 0.5 to 1 g/kg.
Adolescents and adults: 25 to 100 g.
Flatulence: As an antiflatulent, a dose range of 520 to 975 mg has been suggested, to be taken after meals or at the first sign of discomfort and repeated as needed up to 4.16 g daily.
Contraindications
The American Academy of Pediatrics does not recommend administration of activated charcoal in the home, especially in cases of acute poisoning in children.
Charcoal is contraindicated in individuals with unprotected airways and decreased levels of consciousness if not intubated; ingestion of acids or alkalis; cases in which the risk or severity of aspiration is increased; or isolated ingestions of lithium, iron, heavy metals, or ethanol.
Caution should be used in those at risk of gastric hemorrhage or perforation, or in those who have ingested a substance that increases the risk of sudden onset of seizures or sudden decreases in mental status.
Pregnancy/Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking.
Interactions
None well documented.
Adverse Reactions
Emesis is the most common adverse reaction. Use in poisoning is associated with a risk of aspiration and subsequent chemical pneumonitis. GI obstruction can develop in patients receiving repeated doses.
Toxicology
Minimal toxicity is associated with the use of charcoal in hemoperfusion.
Source
Charcoal is produced by pyrolysis and high temperature oxidation of organic materials. Animal charcoal is obtained from items such as charred bones, meat, and blood. Activated charcoal is obtained from charred wood or vegetable matter and treated with various substances to increase its adsorptive power. Amorphous carbons (or charcoals) are taken from the incomplete combustion of natural gas, fats, oils, or resins.Lapus 2007
History
Charcoal has been used for medicinal purposes for thousands of years. Ancient Egyptian papyri document use of charcoal as early as 1500 BC for the adsorption of odor from rotting wounds. Hindu documents from 450 BC record the use of charcoal and sand filters for the purification of drinking water. Hippocrates and Pliny describe the use of charcoal to treat epilepsy, chlorosis, and anthrax.
In 1773, the German-Swedish pharmaceutical chemist Carl Scheele recognized the specific adsorptive powers of charcoal with various gases. At a meeting of the French Academy of Sciences in 1831, a pharmacist ingested several times the lethal dose of strychnine with equal amounts of charcoal and survived. However, the Academy members were unimpressed by this demonstration, and charcoal continued to be used primarily for industrial purposes.
In 1911, the first industrially activated charcoal was made in Austria. Shortly afterward, the use of toxic gases in World War I drove the mass production of activated charcoal suitable for respirators. However, it was not until 1963, after a review article was published in the Journal of Pediatrics, that activated charcoal became more widely accepted in the management of ingested toxins.Lapus 2007
Chemistry
The chemistry of charcoal is complex. Although the purest forms essentially consist of all carbon, the small amounts of impurities that remain following combustion of the source material have been difficult to characterize. Medicinal charcoals have been developed with a high surface area-to-weight ratio in order to maximize adsorption capacity.
The adsorptive properties of charcoal can be increased by treatment with substances such as carbon dioxide, oxygen, air, steam, sulfuric acid, zinc chloride, or phosphoric acid (or combinations of these) at high temperatures (500°C to 900°C). These materials help remove impurities and reduce the particle size of carbon, allowing more adsorption due to increased surface area. One milliliter of finely subdivided and activated medicinal charcoal has a total surface area of approximately 1,000 m2. Medicinal or activated charcoal is a fluffy, fine, black, odorless, and tasteless powder without gritty material. It is insoluble in water or other common solvents but may be suspended for a short time after vigorous shaking.Gennaro 1995
Uses and Pharmacology
Acute poisoning antidote
Activated charcoal has been used in the management of acute toxicity for almost a century. Its large surface area permits the adsorption of a variety of complex chemicals, thereby rendering toxic material unavailable for systemic absorption. In addition, charcoal may interrupt the enterohepatic circulation of compounds excreted into the bile. It is usually coadministered with a laxative, which may hasten the elimination of toxins from the GI tract, resulting in diarrhea and more rapid GI transit time.Juurlink 2016
The use of activated charcoal in the treatment of poisoning is associated with a risk of aspiration and subsequent chemical pneumonitis. Refer to local protocols or seek medical advice regarding use of charcoal in poisoning.
Animal data
Charcoal has been used successfully in animals as an acute poisoning antidoteEl Bahri, Juurlink 2016; however, extrapolation of animal data to the clinical setting is not advised.Juurlink 2016
Clinical data
Volunteer studies suggest that single-dose activated charcoal is more likely to be beneficial if given within 1 hour following ingestion; however, benefit after 1 hour cannot be excluded for poisons with slow gastric motility (eg, anticholinergic substances/drugs, opiates, salicylates). Some authors suggest that activated charcoal is beneficial more than 4 hours following acetaminophen overdose.Chyka 2005, Lapus 2007 In a nonrandomized, prospective, multicenter, observational case series, the administration of activated charcoal to patients more than 4 hours after ingestion of acetaminophen was associated with reduced incidence of liver injury, as measured by elevated serum transaminases and prothrombin time.Spiller 2006
There are no satisfactorily designed clinical studies assessing benefit from single-dose activated charcoal. One study of symptomatic patients who received activated charcoal and some form of gastric evacuation (eg, gastric lavage, ipecac, gastric aspiration) showed that patients receiving gastric aspiration and activated charcoal were less likely to be admitted to an intensive care unit.Chyka 2005
Diarrhea
Clinical data
Limited studies evaluating the use of activated charcoal in irinotecan-induced diarrhea showed reduced severity of diarrhea, resulting in a parallel reduction in loperamide consumption.Michael 2004, Sergio 2008
Dyslipidemia
Animal data
Research reveals no animal data regarding the use of charcoal in dyslipidemia; however, in a study evaluating the effect of charcoal on induced atherosclerosis secondary to nephrectomy in rats, no effect on serum cholesterol or triglycerides was noted.Yamamoto 2011
Clinical data
Older clinical studies suggest that charcoal has an effect on dyslipidemia. Reductions in blood lipid levels in uremic patients treated with charcoal hemoperfusion have been observed, and repeated oral doses of activated charcoal have been reported to be effective in reducing blood lipid concentrations in uremicFriedman 1977 and diabetic patients.Manis 1980 In a study of hypercholesterolemic patients given 8 g of activated charcoal 3 times a day for 4 weeks, total cholesterol and low-density lipoprotein (LDL) cholesterol levels decreased 25% and 41%, respectively. High-density lipoprotein (HDL) cholesterol and the ratio of HDL to LDL increased.Kuusisto 1986 This study has resulted in an increased interest in the use of oral charcoal for the reduction of blood lipid levels, but there is insufficient evidence to confirm the effect on lipid parameters or to determine an appropriate dose.
Gout
Evidence is lacking to support the use of charcoal for treatment of acute gout.Khanna 2012
Flatulence
Clinical data
Capsules of powdered medicinal charcoal are promoted for use in relieving the discomfort of abdominal gas and flatulenceGennaro 1995; however, limited clinical studies have been conducted to support this concept, and 1 study found no effect of charcoal on bloating, abdominal pain, number of flatus episodes, abdominal girth, or cumulative breath hydrogen excretion.Di Stefano 2000
Nephropathy
Clinical data
Limited clinical studies report on adsorption of toxins by charcoal in chronic kidney disease and hemodialysis patients.Schulman 2006, Wang 2012
Wound healing
Clinical data
Limited studies suggest accelerated healing rates using activated charcoal dressings with or without silver.Keiheul 2010, Verdú 2004 In a study of rectal application of activated charcoal, 35.7% of patients had complete healing of chronic anal fistulas after 8 weeks. Zawadzki 2017
Dosing
Acute poisoning antidote
The recommended dosing of activated charcoal is as follows:
Children 1 year and younger
10 to 25 g, or 0.5 to 1 g/kg.
Children 1 to 12 years
25 to 50 g, or 0.5 to 1 g/kg.
Adolescents and adults
25 to 100 g.Chyka 2005, Lapus 2007
On average, activated charcoal should be administered in at least a 10:1 ratio (charcoal to estimated poison dose). It is administered as an aqueous slurry and may be flavored, although flavoring may reduce its effectiveness.Lapus 2007 Use of a charcoal wafer cookie has been evaluated as an alternative to the slurry form of delivery.Klein-Schwartz 2010
The use of multiple-dose activated charcoal is based on the theory that after absorption, drugs will reenter the gut by passive diffusion if the concentration in the gut is lower than in the blood. Administration of more than 2 doses of activated charcoal may maintain a concentration gradient, causing the drug to continuously pass into the gut where it is adsorbed by the charcoal. Multiple-dose activated charcoal is likely to assist in decreasing absorption when large amounts of the drug are ingested and dissolution is delayed (masses and bezoars [ie, salicylates]), when drugs exhibit a delayed- or prolonged-release phase (ie, enteric coated, sustained release), or when reabsorption can be prevented (enterohepatic circulation of active drug or active metabolites [eg, carbamazepine]).Lapus 2007
Flatulence
Capsules should be taken 2 hours before or 1 hour after any oral medication. A dose range of 520 to 975 mg has been suggested, to be taken after meals or at the first sign of discomfort and repeated as needed up to 4.16 g daily.Gennaro 1995
Pregnancy / Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking.
Interactions
Because activated charcoal can adsorb drugs in the GI tract, it should be taken 2 hours before or 1 hour after other medications.Gennaro 1995
Avoid simultaneous administration of charcoal and the emetic ipecac; charcoal may adsorb the ipecac and render it ineffective. The American Academy of Pediatrics and the American Association of Poison Control Centers recommend that ipecac syrup and charcoal not be stocked at home.AAP 2003
Adverse Reactions
Of the complications reported with the administration of charcoal as a slurry (antidote), aspiration has the potential to be the most serious but is rare (possibly less than 2% incidence).Juurlink 2016, Lapus 2007 When aspiration does occur following charcoal administration, it is difficult to attribute subsequent pulmonary problems to the charcoal as opposed to the gastric contents; complications are likely due to the presence of both gastric contents and charcoal.Chyka 2005 Chemical pneumonitis may occur subsequent to aspiration.Juurlink 2016, Lapus 2007
Emesis is the most common adverse reaction in the administration of activated charcoal, with a reported incidence of 6% to 26%.Lapus 2007 The American Academy of Clinical Toxicology position statement on single-dose activated charcoal states that the influences of rate and volume of charcoal administration, ingested toxic substances, and premorbid conditions on the incidence of vomiting are unknown. However, in a study of children 18 years and younger, previous vomiting and nasogastric tube administration were found to be the most important independent risk factors for vomiting sorbitol content. Large charcoal volume or rapid administration rate did not increase vomiting risk.Graff 2002, Osterhoudt 2004
The oral use of charcoal has been associated with adverse reactions, including GI obstruction due to formation of briquettes, which was observed in patients who received repeated doses.Anderson 1987, Watson 1986
Toxicology
In general, there is little toxicity associated with the charcoal component of hemoperfusion when used for the removal of toxins from the blood following acute overdose.
References
Disclaimer
This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.
This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.
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