Activated charcoal Dosage, Use and Contraindications

When utilised as soon as possible after ingesting a chemical substance, ideally within an hour, activated charcoal works by adsorbing the ingested toxin or poison. Although the dose for various poisons may vary, they are essentially the same. Sustained-release formulations, salicylates, and drugs with delayed absorption can all be utilised after an hour has passed since intake. It may be suggested that patients take repeated doses of activated charcoal if they take high or potentially fatal dosages of carbamazepine, dapsone, phenobarbital, quinine, or theophylline. Other oral anticoagulants, including vitamin K antagonists like warfarin, are also used off-label to treat cerebral bleeding.


Toxins and drugs where activated charcoal may be used:

 

  • Calcium channel blockers, especially verapamil, and diltiazem
  • Beta Blockers
  • Amisulpride
  • Chloroquine, hydroxychloroquine or quinine
  • Flecainide
  • Methotrexate
  • Carbamazepine
  • Colchicine
  • Paraquat/diquat

Toxins and drug overdose where Charcoal may not be helpful and/ or contraindicated:

    • Ingestion of corrosives like Acids and Alkalis.
    • Cyanide ingestion.
    • Ethanol or methanol
    • Eucalyptus and Essential Oils
    • Fluoride
    • Hydrocarbons
    • Metals including Lithium, Iron compounds, potassium, and lead
    • Mineral acids like Boric acid

Activated charcoal Dose in Adults

Activated charcoal dosage in the treatment of Acute poisoning:

  • Single dose regimen:
    • 25-100 grams
  • Multi-dose regimen:
    • 50-100 grams followed by 25-50 g every 4 hrs.

Off-label use in the treatment o Intracranial haemorrhage secondary to oral anticoagulants other than vitamin K antagonist:

  • 50 gms within 2 hours of ingestion of dabigatran (an oral direct thrombin inhibitor) or apixaban, edoxaban, or rivaroxaban (oral direct factor Xa inhibitors).
  • Prothrombin complex concentrate activated PCC, andexanet alfa for the reversal of direct factor Xa inhibitors, or idarucizumab for the reversal of dabigatran may all be administered concurrently with activated charcoal.

Activated charcoal Dose in Children

Activated charcoal dosage in Acute poisoning: 

  • Single dose:
    • The Dose is calculated according to the patient's age as given below:
      • Infants less than 1 year:
      • Adolescents:
        • Manufacturer's labeling:
          • 50 - 100 gms or 1 - 2 gms/kg or 50 - 100 gms if the weight is 32 kgs or more.
          • AACT recommendation: 25 - 100 g
      • Children 1 - 12 years:
        • Manufacturer's labeling:
          • 25 to 50 g or 1 - 2 g/kg or 15 - 30 gms if the weight is more than 16 kgs
          • AACT recommendation: 25 - 50 g

Single activated charcoal dosage with Sorbitol:

  • Infants less than 1 y/o:
    • Not suggested
  • Adolescents:
    • Actidose with Sorbitol: 50 grams
    • Weight 32 kgs or more: 1-2 g per kg or 50-100 grams
  • Children 1-12 years:
    • Weight 16 - 32 kg: 25 grams
    • Weight 32 kgs or more: 25 to 50 g

For life-threatening ingestions of carbamazepine, dapsone, phenobarbital, quinine, or theophylline, several dosages are only permitted.

  • Manufacturer's labelling:
    • Children 1-12 years:
      • 25-50 grams every 4-6 hrs
    • Infants less than 1 year:
      • 1 gm per kg every 4-6 hrs
    • Adolescents:
      • 50-100 grams every four to six hrs

Pregnancy Risk Factor B

  • Because it is not systemically absorbed after oral treatment, activated charcoal has no impact on pregnancy outcomes.

Use activated charcoal during breastfeeding

  • Activated charcoal does not cause any harm to the child who is fed it after oral administration.

Activated charcoal Dose in Renal Disease:

  • In individuals with renal illness, there has been no advised dosage modification.

Activated charcoal Dose in Liver Disease:

  • In individuals with renal illness, there has been no advised dosage modification.

Common Side Effects of Activated charcoal Include: 

  • Ophthalmic:
    • Corneal abrasion
  • Gastrointestinal:
    • Mouth discoloration
    • Vomiting
    • Constipation
    • Dental discoloration
    • Abdominal distention
    • Appendicitis
    • Fecal discoloration
    • Intestinal obstruction
  • Respiratory:
    • Respiratory failure
    • Aspiration

Contraindications to Activated charcoal include:

  • Anatomically disordered gastrointestinal tract and intestinal obstruction.
  • Patients at high risk for gastrointestinal haemorrhage and perforation
  • Patients in a coma with unprotected airways.

Warnings and Precautions​​​​​​​

  • Vomiting:
    • It can cause vomiting, especially if it is administered in large quantities or given quickly.
  • Reduced bowel movements
    • Patients with intestinal obstruction should avoid it and use it with caution.

Activated charcoal: Drug Interaction

Note: Drug Interaction Categories:

  • Risk Factor C: Monitor When Using Combination
  • Risk Factor D: Consider Treatment Modification
  • Risk Factor X: Avoid Concomitant Use

Risk Factor D (Consider therapy modifications)

Leflunomide The blood levels of Leflunomide's active metabolites may be reduced by charcoal activation. Management: If you're not actively utilising this combo to improve leflunomide elimination, think about switching to charcoal. It is doubtful that this interaction can be prevented by using a different medication. 
Teriflunomide The serum concentration of Teriflunomide may be decreased by activated charcoal. Management: This combination should not be used to increase teriflunomide removal. This interaction is unlikely to be avoided by separate drug administration.

Monitoring Parameters:

  • Monitor bowel sounds and consciousness level prior to administering it.

How to administer Activated charcoal?

  • It is administered via a nasogastric tube after mixing it in water or saline and making a liquid solution of it.
  • The usual procedure is to administer half the dose and then suck it back and discard it.
  • The remaining half can be administered and left in the gastrointestinal tract to adsorb the remaining toxins.
  • If the drug is administered orally, it may be mixed with a flavouring agent other than chocolate and milk to improve its palatability.
  • Always listen to your bowels before giving them to someone. The risk of vomiting can be decreased by adding antiemetics.
  • Unconscious patients should have their airways secured before administering activated charcoal.

Mechanism of action of Activated charcoal:

  • It prevents toxic substances from being absorbed by adsorbing them, thereby limiting their systemic toxicity.
  • The effectiveness of activated charcoal depends on when it is administered after consumption, as shown below:
    • Within 30 minutes of ingestion, administered:
      • Systemic absorption was reduced by 47.3%
    • Within 60 minutes of ingestion
      • Reduced systemic absorption of 40%
    • Within 120 minutes of ingestion, administered:
      • Reduced systemic absorption by 16.5%
    • Within 180 minutes of ingestion
      • Systemic absorption was reduced by 21.3%
    • Within 240 minutes after ingestion
      • Reduced systemic absorption by 32.5%

It isn't absorbed From the gastrointestinal tract excreted In faeces.

Activated charcoal international brands:

 

 

  • Kerr Insta-
  • Char in Sorbitol
  • Kerr Insta-Char
  • Acticarb
  • Allocholum
  • Antipois
  • Bekarbon
  • Actidose-Aqua
  • Actidose/Sorbitol
  • Biocarbon
  • Ca-R-Bon
  • Carbobel Mono
  • Carbomint
  • Carbomix
  • Carbosorb
  • Char-Flo with Sorbitol
  • EZ Char
  • Carbosorb X
  • Carbosorb XS
  • Carbotox
  • Carbotural
  • Charbogir
  • Charcodote
  • Charcotrace
  • Deltacarbon
  • JL Bragg's Medicinal Charcoal
  • Karbosorb
  • Koal
  • Kremezin
  • Mamograf
  • Norit
  • RCOL
  • Sorbex
  • Ultra Carbon
  • Ultracarbon
  • Yo'Come Penney

Activated charcoal Brands in Pakistan:

Available as activated charcoal powder

Charcoal (Activated) [Caps 260 mg]

Karbon Neo Medix