Activated charcoal (medication)
|Trade names||CharcoAid, others|
|Main uses||Used in certain poisoning|
|By mouth, nasogastric tube|
|Defined daily dose||5 gm|
|Typical dose||50 gm|
Activated charcoal, also known as activated carbon, is a medication used to treat poisonings that occurred by mouth. To be effective it must be used within a short time of the poisoning occurring, typically an hour. It does not work for poisonings by cyanide, corrosive agents, iron, lithium, alcohols, or malathion. It may be taken by mouth or given by a nasogastric tube. Other uses include inside hemoperfusion machines.
Common side effects include vomiting, black stools, diarrhea, and constipation. The more serious side effect, pneumonitis, may result if aspirated into the lungs. Gastrointestinal obstruction and ileus are less common but serious adverse effects. Use in pregnancy and breastfeeding is safe. Activated charcoal works by adsorbing the toxin.
While charcoal has been used since ancient times for poisonings, activated charcoal has been used since the 1900s. It is on the World Health Organization's List of Essential Medicines. The wholesale costs in the developing world is between US$0.46 and US$0.86 per dose. In the United States a course of treatment costs less than US$25.
Activated charcoal is used to treat many types of oral poisonings such as phenobarbital and carbamazepine. It is not effective for a number of poisonings including: strong acids or bases, iron, lithium, arsenic, methanol, ethanol or ethylene glycol.
No randomized controlled trials have shown activated charcoal improves outcomes and routine use is not recommended. In a study of acute poisonings from agricultural pesticides and yellow oleander seeds, the administration of activated carbon did not affect survival rates.
Tablets or capsules of activated carbon are used in many countries as an over-the-counter drug to treat diarrhea, indigestion, and flatulence. There is some evidence of its effectiveness to prevent diarrhea in cancer patients who have received irinotecan. It can interfere with the absorption of some medications, and lead to unreliable readings in medical tests such as the guaiac card test. Activated carbon is also used for bowel preparation by reducing intestinal gas content before abdominal radiography to visualize bile and pancreatic and renal stones. A type of charcoal biscuit has also been marketed as a pet care product.
Claims that activated charcoal will do things such as whiten teeth, cure alcohol-induced hangovers, and prevent bloating, are not supported by evidence. Activated charcoal cleanses also lack evidence and are considered pseudoscience.
The defined daily dose is 5 grams (by mouth) In people over 12 years of age the typical dose is 50 grams, while in those 1 to 12 years old the dose is 25 grams. Under 1 year old it is 1 gram per kilogram of body weight.
Incorrect application (e.g. into the lungs) results in pulmonary aspiration which can sometimes be fatal if immediate medical treatment is not initiated. The use of activated carbon is contraindicated when the ingested substance is an acid, an alkali, or a petroleum product.
Mechanism of action
In cases of suspected poisoning, medical personnel administer activated carbon on the scene or at a hospital's emergency department. In rare situations, it may also be used in a hemoperfusion system to remove toxins from the blood stream of poisoned patients. Activated carbon has become the treatment of choice for many poisonings, and other decontamination methods such as ipecac-induced emesis or stomach pumping are now used rarely.
- Binding of the poison to prevent stomach and intestinal absorption. Reversible binding using a cathartic, such as sorbitol, may be added.
- It interrupts the enterohepatic and enteroenteric circulation of some drugs/toxins and their metabolites.
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