- Actidose® with Sorbitol [OTC];
- Actidose®-Aqua [OTC];
- Char-Caps [OTC];
- Charcoal Plus® DS [OTC];
- CharcoCaps® [OTC];
- EZ-Char® [OTC];
- Kerr Insta-Char® [OTC];
- Requa® Activated Charcoal [OTC]
- Charcadole® TFS;
- Charcadole®, Aqueous
Oral: 25-100 g as a single dose; if multiple doses are needed, additional doses may be given as 12.5 g/hour or equivalent (eg, 25 g every 2 hours)
Note: ~10 g of activated charcoal for each 1 g of toxin is considered adequate; this may require multiple doses. If sorbitol is also used, sorbitol dose should not exceed 1.5 g/kg. When using multiple doses of charcoal, sorbitol should be given with every other dose (not to exceed 2 doses/day)
Dietary supplement: Oral: 500-520 mg after meals; may repeat in 2 hours if needed (maximum: 10 g/day)
<1 year: 0.5-1 g/kg (10-25 g) as a single dose; if multiple doses are needed, give as 0.25 g/kg/hour or equivalent (eg, 0.5 g/kg every 2 hours)
1-12 years: 0.5-1 g/kg (25-50 g) as a single dose; if multiple doses are needed, give as 0.25 g/kg/hour or equivalent (eg, 0.5 g/kg every 2 hours)
>12 years: Refer to adult dosing.
Note: ~10 g of activated charcoal for each 1 g of toxin is considered adequate; this may require multiple doses. If sorbitol is also used, sorbitol dose should not exceed 1.5 g/kg. When using multiple doses of charcoal, sorbitol should be given with every other dose (not to exceed 2 doses/day).
Char-Caps: 260 mg
CharcoCaps®: 260 mg [dietary supplement]
Pellets for suspension, oral:
EZ-Char®: 25 g/bottle (1s)
Powder for suspension, oral: USP: 100% (30 g, 240 g)
Actidose®-Aqua: 15 g (72 mL); 25 g (120 mL); 50 g (240 mL)
Kerr Insta-Char®: 25 g (120 mL); 50 g (240 mL) [contains propylene glycol (in flavoring packet), sodium benzoate]
Kerr Insta-Char®: 50 g (240 mL) [contains sodium benzoate]
Suspension, oral [with sorbitol]:
Actidose® with Sorbitol: 25 g (120 mL); 50 g (240 mL)
Kerr Insta-Char®: 25 g (120 mL); 50 g (240 mL) [contains propylene glycol (in flavoring packet), sodium benzoate, sorbitol]
Requa® Activated Charcoal: 250 mg
Tablet, enteric coated, oral:
Charcoal Plus® DS: 250 mg
Actidose® may be confused with Actos®
Endocrine & metabolic: Hypernatremia, hypokalemia, and hypermagnesemia may occur with coadministration of cathartics
Gastrointestinal: Vomiting (incidence may increase with sorbitol), diarrhea (with sorbitol), constipation, swelling of abdomen, bowel obstruction, appendicitis
Respiratory: Aspiration (both gastric contents and charcoal)
Miscellaneous: Fecal discoloration (black)
• Vomiting: Charcoal may cause vomiting; avoid use in hydrocarbon and caustic ingestions.
• Decreased peristalsis: Use with caution in patients with decreased peristalsis.
Concurrent drug therapy issues:
• Ipecac: When using ipecac with charcoal, ensure ipecac-induced vomiting has ceased prior to administering charcoal.
• Cathartics (eg, sorbitol, mannitol, magnesium sulfate): Coadministration of a cathartic is not recommended secondary to lack of compelling evidence and the increased morbidity associated with their use. If charcoal is administered with a cathartic, avoid excessive fluid and electrolyte losses, especially in children <1 year of age.
• Pediatrics: Charcoal with sorbitol not recommended in children <1 year of age.
Dosage form specific issues:
• Propylene glycol: Commercial charcoal products may contain propylene glycol.
• Appropriate use: Not effective for cyanide, mineral acids, caustic alkalis, organic solvents, iron, ethanol, methanol, or lithium poisoning
• Efficacy: Most effective when administered within 30-60 minutes of ingestion.
Does not enter breast milk/compatible
- Bekarbon (ID);
- Ca-R-Bon (TH);
- Carbo Medicinalis (PL);
- Carbomix (FR, SE);
- Carbon Natural (UY);
- Carbosorb (NZ);
- Carbosorb S (NZ);
- Carbosorb X (AU);
- Carbosorb XS (AU);
- Carbotural (MX);
- Charcodote (GB, HK, KP);
- Charcotrace (AU);
- Deltacarbon (TH);
- Mamograf (AR);
- Norit (IL);
- RCOL (IN);
- Ultracarbon (SG)
Alaspää AO, Kusima MJ, Hoppu K, et al, “Feasibility Study on Activated Charcoal Given Prehospital by Emergency Medical System (EMS) in Acute Intoxications,” J Toxicol Clin Toxicol, 2002, 40(3):312-3.
Bond GR, “The Role of Activated Charcoal and Gastric Emptying in Gastrointestinal Decontamination: A State-of-the-Art Review,” Ann Emerg Med, 2002, 39(3):273-86. [PubMed 11867980]
Christophersen AB, Hoegberg LC, Angelo HR, et al, “Activated Charcoal in a Simulated Paracetamol Overdose: Downscaling of Dose to 10 Grams – Preliminary Results,” J Toxicol Clin Toxicol, 2002, 40(5):696.
Chyka PA, Seger D, Krenzelok EP, et al, American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists, “Position Paper: Single-Dose Activated Charcoal,” Clin Toxicol (Phila), 2005, 43(2):61-87 (review).
Cooney DO, “Development of Palatable Formulations,” Activated Charcoal in Medical Applications, Cooney DO, ed, New York, NY: Marcel Dekker, Inc, 1995, 397-417.
Cooper GM, Le Coteur DG, Richardson DB, et al, “A Randomized Clinical Trial of Activated Charcoal for the Routine Management of Oral Drug Overdose,” Acad Emerg Med, 2002, 9(5):487.
Dagnone D, Matsui D, and Reider MJ, “Assessment of the Palatability of Vehicles for Activated Charcoal in Pediatric Volunteers,” Pediatr Emerg Care, 2002, 18(1):19-21. [PubMed 11862132]
Dorrington CL, Johnson DW, Brant R, “The Frequency of Complications Associated With the Use of Multiple-Dose Activated Charcoal,” Ann Emerg Med, 2003, 41(3):370-7. [PubMed 12605204]
Heard K, “Gastrointestinal Decontamination,” Med Clin N Am, 2005, 89(6):1067-78 (review). [PubMed 16227054]
Higgins T, Curry S, Brooks D, et al, “Iatrogenic Administration of Propylene Glycol With Activated Charcoal,” J Toxicol Clin Toxicol, 2000, 38(5):529.
Holmes C, Schauben J, and Hasan MY, “An Evaluation of the Incidence of Emesis Following Oral Bolus Dosing vs Gradual Administration Regimens of Activated Charcoal,” J Toxicol Clin Toxicol, 1998, 36(5):431-2.
Justice HM, Knapp BJ, Pianalto DA, et al, “Failure of Emergency Medical Services Providers to Administer Activated Charcoal Add to Emergency Delay,” Acad Emerg Med, 2006, 13(5):S180.
Keyes C and DeTamble L, “Prehospital Activated Charcoal: A Prospective Randomized Trial,” J Toxicol Clin Toxicol, 1999, 37(5):610.
Merigian KS and Blaho KE, “Single-Dose Oral Activated Charcoal in the Treatment of the Self-Poisoned Patient: A Prospective, Randomized, Controlled Trial,” Am J Ther, 2002, 9(4):301-8. [PubMed 12115019]
Seger D, “Single-Dose Activated Charcoal-Backup and Reassess,” J Toxicol Clin Toxicol, 2004, 42(1):101-10. [PubMed 15083946]
Vale JA, Krenzelok EP and Barceloux GD et al, American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists, “Position Statement and Practice Guidelines on the Use of Multiple-Dose Activated Charcoal in the Treatment of Acute Poisoning,” Clin Toxicol, 1999, 37(6):731-51.