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Actidose Plus Sorbitol Side Effects

Generic Name: charcoal / sorbitol

Note: This document contains side effect information about charcoal / sorbitol. Some of the dosage forms listed on this page may not apply to the brand name Actidose Plus Sorbitol.

Applies to charcoal/sorbitol: oral suspension

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 peritoneum, diarrhea, 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 of a charcoal bezoar and small bowel obstruction following administration of 30 to 60 grams of activated charcoal via nasogastric tube every 4 to 6 hours for 5 days has been reported.

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 > 12 years, administration by nasogastric or orogastric tube, and ingestion of emetogenic drug or chemical. Charcoal with sorbitol solution did not appear to significantly increase the risk of vomiting.

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 which can be unpalatable.[Ref]

Ocular

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

Ocular side effects have included corneal abrasions.[Ref]

Metabolic

Metabolic side effects result primarily from the sorbitol and have included electrolyte abnormalities, dehydration, and shock.[Ref]

Respiratory

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]

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

References

1. 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

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

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

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

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

6. Sack RB, Cassells J, Mitra R, Merritt C, Butler T, Thomas J, Jacobs B, Chaudhuri A, Mondal A "The use of oral replacement solutions in the treatment of cholera and other severe diarrhoeal disorders." Bull World Health Organ 43 (1970): 351-60

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

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

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

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

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

12. "Product Information. Liqui-Char with Sorbitol (charcoal-sorbitol)." Jones Medical-Western Research, St. Louis, MO.

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

14. 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

15. 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]):

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

17. 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

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

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

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

21. 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

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

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

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

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