Charcoal Side Effects
For the Consumer
Applies to charcoal: capsules, tablets
Check with your doctor if any of these most COMMON side effects persist or become bothersome:
Seek medical attention right away if any of these SEVERE side effects occur while taking charcoal:
Constipation; diarrhea; temporary darkening of the stool; vomiting.
Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue).
For Healthcare Professionals
Applies to charcoal: compounding powder, oral capsule, oral delayed release tablet, oral granule for reconstitution, oral powder for reconstitution, oral suspension, oral tablet
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, 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 report has described charcoal bezoar and small bowel obstruction following administration of 30 to 60 g of activated charcoal via nasogastric tube every 4 to 6 hours for 5 days.
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 greater than 12 years, administration by nasogastric or orogastric tube, and ingestion of emetogenic drug or chemical.
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 that can be unpalatable.[Ref]
Metabolic side effects have included hypernatremia, hypermagnesemia. electrolyte abnormalities, dehydration, and shock.[Ref]
Metabolic side effects occur primarily when sorbitol is combined with charcoal. Multiple-dose activated charcoal has been associated with hypernatremia and hypermagnesemia.[Ref]
Respiratory side effects have included bronchiolitis obliterans, empyema, and Adult Respiratory Distress Syndrome.[Ref]
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]
Ocular side effects have included corneal abrasions.[Ref]
Corneal abrasions may occur if charcoal comes in contact with eyes.[Ref]
Exacerbation of variegate porphyria may lead to increases in skin lesions, and urine and plasma porphyrins.[Ref]
Hematologic side effects have included exacerbation of variegate porphyria.[Ref]
1. Atkinson SW, Young Y, Trotter GA "Treatment with activated charcoal complicated by gastrointestinal obstruction requiring surgery." BMJ 305 (1992): 563
2. Neuvonen PJ "Clinical pharmacokinetics of oral activated charcoal in acute intoxications." Clin Pharmacokinet 7 (1982): 465-89
3. Daniel V "Fatal pulmonary aspiration of oral activate charcoal." BMJ 297 (1988): 684
4. Mariani PJ, Pook N "Gastrointestinal tract perforation with charcoal peritoneum complicating orogastric intubation and lavage." Ann Emerg Med 22 (1993): 606-9
5. Osterhoudt KC, Durbin D, Alpern ER, Henretig FM "Risk factors for emesis after therapeutic use of activated charcoal in acutely poisoned children." Pediatrics 113 (2004): 806-10
6. Watson WA "Comment: misadventures with activated charcoal." Ann Pharmacother 29 (1995): 84-5
7. Mauro LS, Nawarskas JJ, Mauro VF "Misadventures with activated charcoal and recommendations for safe use." Ann Pharmacother 28 (1994): 915-24
8. Herrington AM, Clifton GD "Toxicology and management of acute drug ingestions in adults." Pharmacotherapy 15 (1995): 182-200
9. 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
10. Lopes de Freitas JM, Ferreira MG, Brito MJ "Charcoal deposits in the esophageal and gastric mucosa." Am J Gastroenterol 92 (1997): 1359-60
11. Spyker DA, Minocha A "Toxicodynamic approach to management of the poisoned patient." J Emerg Med 6 (1988): 117-20
12. 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
13. Orisakwe OE "Activated charcoal: is failure to use it negligence or ignorance?" South Med J 87 (1994): 165-8
14. Watson WA, Cremer KF, Chapman JA "Gastrointestinal obstruction associated with multiple-dose activated charcoal." J Emerg Med 4 (1986): 401-7
15. 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
16. Dorrington CL, Johnson DW, Brant R "The frequency of complications associated with the use of multiple-dose activated charcoal." Ann Emerg Med 41 (2003): 370-7
17. Allerton JP, Strom JA "Hypernatremia due to repeated doses of charcoal-sorbitol." Am J Kidney Dis 17 (1991): 581-4
18. Harris CR, Filandrinos D "Accidental administration of activated charcoal into the lung: aspiration by proxy." Ann Emerg Med 22 (1993): 1470-3
19. Menzies DG, Busuttil A, Prescott LF "Fatal pulmonary aspiration of oral activated charcoal." BMJ 297 (1988): 459-60
20. 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
21. Harsch HH "Aspiration of activated charcoal." N Engl J Med 314 (1986): 318
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. Justiniani FR, Hippalgaonkar R, Martinez LO "Charcoal-containing empyema complicating treatment for overdose." Chest 87 (1985): 404-5
25. Tomaszewski C "Activated charcoal--treatment or toxin? [comment]." J Toxicol Clin Toxicol 37 (1999): 17-8
26. 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]):
27. Hift RJ, Todd G, Meissner PN, Kirsch RE "Administration of oral activated charcoal in variegate porphyria results in a paradoxical clinical and biochemical deterioration." Br J Dermatol 149 (2003): 1266-9
Not all side effects for charcoal may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.
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