(CHAR kole AK tiv ay ted)
- Activated Carbon
- Activated Charcoal
- Adsorbent Charcoal
- Liquid Antidote
- Medicinal Carbon
- Medicinal Charcoal
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Actidose-Aqua: 15 g/72 mL (72 mL); 25 g/120 mL (120 mL); 50 g/240 mL (240 mL) [sweet flavor]
Actidose/Sorbitol: 25 g/120 mL (120 mL); 50 g/240 mL (240 mL) [sweet flavor]
Kerr Insta-Char: 25 g/120 mL (120 mL); 50 g/240 mL (240 mL) [contains fd&c red #40, methylparaben sodium, propylene glycol, propylparaben sodium, sodium benzoate; cherry flavor]
Kerr Insta-Char: 50 g/240 mL (240 mL) [contains propylene glycol]
Kerr Insta-Char in Sorbitol: 25 g/120 mL (120 mL); 50 g/240 mL (240 mL) [contains fd&c red #40, methylparaben sodium, propylene glycol, propylparaben sodium, sodium benzoate; cherry flavor]
Char-Flo with Sorbitol: 25 g (120 mL)
Suspension Reconstituted, Oral:
EZ Char: 25 g (1 ea) [contains bentonite]
Brand Names: U.S.
- Actidose-Aqua [OTC]
- Actidose/Sorbitol [OTC]
- Char-Flo with Sorbitol [OTC]
- EZ Char [OTC]
- Kerr Insta-Char in Sorbitol [OTC]
- Kerr Insta-Char [OTC]
Adsorbs toxic substances, thus inhibiting GI absorption and preventing systemic toxicity. Administration of multiple doses of charcoal may interrupt enteroenteric, enterohepatic, and enterogastric circulation of some drugs; may also adsorb any unabsorbed drug which remains in the gut.
Not absorbed from the GI tract
Feces (as charcoal)
Use: Labeled Indications
Suspension: Activated charcoal is a nonabsorbable adsorbent that may be considered in the management of poisonings when gastrointestinal decontamination of drugs or chemicals is indicated (eg, presentation to a treatment facility within 1 hour of ingestion; but use beyond 1 hour is not contraindicated). Activated charcoal is generally an effective adsorbent of drugs and chemicals with a molecular weight range of 100 to 1,000 daltons. Multidose activated charcoal may be considered if a patient has ingested a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine, or theophylline (Vale 1999).
Capsules, tablets: Digestive aid
Off Label Uses
Intracranial hemorrhage associated with oral non-vitamin K antagonist anticoagulants
Based on the Neurocritical Care Society and the Society of Critical Care Medicine guideline for reversal of antithrombotics in intracranial hemorrhage, activated charcoal is suggested for intubated intracranial hemorrhage patients presenting within 2 hours of ingestion of an oral direct factor Xa inhibitor (eg, apixaban, edoxaban, rivaroxaban) or an oral direct thrombin inhibitor (dabigatran); use is suggested in patients with enteral access and/or alert patients with low aspiration risk. Concomitant agents are also recommended in certain paitients (ie, 4-factor prothrombin complex concentrate [PCC] or activated PCC [aPCC] for direct factor Xa inhibitor reversal or idarucizumab for dabigatran reversal).
There are no absolute contraindications listed within the manufacturer’s labeling.
Note: The American Academy of Clinical Toxicology (AACT) and European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) consider the following to be contraindications to the use of charcoal (Chyka 2005; Vale 1999): Presence of intestinal obstruction or GI tract not anatomically intact; patients at risk of GI hemorrhage or perforation; patients with an unprotected airway (eg, CNS depression without intubation); if use would increase the risk and severity of aspiration
Acute poisoning: Oral, NG: Note: Some products may contain sorbitol; coadministration of a cathartic, including sorbitol, is not recommended due to the potential risk of severe dehydration and electrolyte imbalance. Some clinicians still recommend dosing activated charcoal in a 10:1 (charcoal:poison) ratio for optimal efficacy (Gude 2009); however, the amount of poison ingested is commonly unknown, which makes this approach challenging and often impractical (Chyka 2005).
Single dose (Chyka 2005): 25 to 100 g
Multidose: Initial dose: 50 to 100 g followed by 25 to 50 g every 4 hours
Intracranial hemorrhage associated with oral non-vitamin K antagonist anticoagulants (off-label use): Oral, enteral: 50 g within 2 hours of ingestion of an oral direct thrombin inhibitor (dabigatran) or an oral direct factor Xa inhibitor (eg, apixaban, edoxaban, or rivaroxaban). Concomitant agents are also recommended in certain patients (ie, 4-factor prothrombin complex concentrate [PCC] or activated PCC [aPCC] for direct factor Xa inhibitor reversal or idarucizumab for dabigatran reversal) (NCS/SCCM [Frontera 2016]).
Refer to adult dosing.
Acute poisoning: Oral, NG: Note: Some products may contain sorbitol; coadministration of a cathartic, including sorbitol, is not recommended due to the potential risk of severe dehydration and electrolyte imbalance, especially in children. Some clinicians still recommend dosing activated charcoal in a 10:1 (charcoal:poison) ratio for optimal efficacy (Gude 2009); however, the amount of poison ingested is commonly unknown, which makes this approach challenging and often impractical (Chyka 2005).
Single dose (Chyka 2005):
Infants <1 year: 10 to 25 g; Note: Although dosing by body weight is reported in children (0.5 to 1 g/kg) and published in many resources, there are no data or scientific rationale to support this recommendation.
Children 1 to 12 years: 25 to 50 g
Children >12 years: Refer to adult dosing.
Multidose: Initial dose: 25 to 50 g; followed by multiple doses of 10 to 25 g every 4 hours
Powder: Dilute with at least 8 mL of water per 1 g of charcoal, or mix in a charcoal to water ratio of 1:4 to 1:8; mix vigorously to form a slurry (eg, mix 25 g with sufficient tap water to create a 4-ounce slurry or mix 50 g with sufficient tap water to create an 8-ounce slurry).
Flavoring agents (eg, chocolate syrup, concentrated fruit juice) or thickening agents (eg, bentonite, carboxymethylcellulose) can enhance charcoal's palatability; however, they may interfere with the ability of activated charcoal to adsorb poisons. Check for the presence of bowel sounds before administration. IV antiemetics may be required to reduce the risk of vomiting. The activated charcoal container should be agitated thoroughly before administration. The container should be rinsed with a small quantity of water to insure that the patient has received all of the activated charcoal (Krenzelok 1991).
Capsules and tablets should not be used for the treatment of poisoning.
Adsorbs gases from air, store in a closed container.
Leflunomide: Charcoal, Activated may decrease serum concentrations of the active metabolite(s) of Leflunomide. Management: Unless using this combination to intentionally enhance leflunomide elimination, consider an alternative to charcoal when possible. Separating drug administration is not likely to be effective at avoiding this interaction. Consider therapy modification
Teriflunomide: Charcoal, Activated may decrease the serum concentration of Teriflunomide. Management: Unless using this combination to intentionally enhance teriflunomide elimination, consider an alternative to charcoal when possible. Separating drug administration is not likely to be effective at avoiding this interaction. Consider therapy modification
Frequency not defined.
Gastrointestinal: Abdominal distention, appendicitis, constipation, dental discoloration (black; temporary), fecal discoloration (black), intestinal obstruction, mouth discoloration (black; temporary), vomiting
Ophthalmic: Corneal abrasion (with direct contact)
Respiratory: Aspiration, respiratory failure
Concerns related to adverse effects:
• Vomiting: Charcoal may cause vomiting; the risk appears to be greater when charcoal is administered with sorbitol (Chyka 2005). IV antiemetics may be required to reduce the risk of vomiting or to control vomiting to facilitate administration (Vale 1999).
• Decreased peristalsis: Use with caution in patients with decreased peristalsis.
Concurrent drug therapy issues:
• Ipecac: Ipecac should not be administered routinely in the management of poisoned patients (AACT 2004b). In addition, use may delay the administration of or decrease the effectiveness of activated charcoal.
• Cathartics (eg, sorbitol, mannitol, magnesium sulfate): Coadministration of a cathartic is not recommended; cathartics have not been demonstrated to change patient outcome and have no role in the management of the poisoned patient. Cathartics subject the patient to the risk of developing significant fluid and electrolyte abnormalities (AACT 2004a).
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer’s labeling.
• Capsules: Not recommended for use in the treatment of poisoning.
• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP ["Inactive" 1997]; Zar 2007).
• Sorbitol: Some products may contain sorbitol; coadministration of a cathartic, including sorbitol, is not recommended. Do not use products containing sorbitol in patients with a genetic intolerance to fructose or in patients who are dehydrated; may cause excessive diarrhea.
• Tablets: Not recommended for use in the treatment of poisoning.
• Appropriate use: Not effective in the treatment of poisonings due to the ingestion of low molecular weight compounds such as cyanide, iron, ethanol, methanol, or lithium. Avoid use in hydrocarbon and caustic ingestions.
• Efficacy: Most effective when administered within 30-60 minutes of ingestion.
• Multidose administration: Based on experimental and clinical studies, multidose activated charcoal, in most acute poisonings, has not been shown to reduce morbidity or mortality (Vale 1999). It may be considered if a patient has ingested a life-threatening amount of carbamazepine, dapsone, phenobarbital, phenytoin, quinine, or theophylline, although no controlled studies have demonstrated clinical benefit.
Activated charcoal is not absorbed systemically following oral administration. Use during pregnancy is not expected to result in significant exposure to the fetus. In general, medications used as antidotes should take into consideration the health and prognosis of the mother; antidotes should be administered to pregnant women if there is a clear indication for use and should not be withheld because of fears of teratogenicity (Bailey 2003).
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience dark stools (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.
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- Drug class: antidotes