Activated charcoal occurs as a fine, black, odorless, tasteless powder that is insoluble in water or alcohol. Commercially available activated charcoal products may differ in their adsorptive properties, but one gram must adsorb 100 mg of strychnine sulfate in 50 ml of water to meet USP standards. Activated charcoal has several synonyms including: active carbon, activated carbon, adsorbent charcoal, decolorizing carbon, or medicinal charcoal
Activated charcoal adsorbs many chemicals and drugs in the upper GI tract thereby preventing or reducing their absorption. While activated charcoal also adsorbs various nutrients and enzymes from the gut, when used for acute poisonings, no clinical significance usually results. Activated charcoal reportedly is not effective in adsorbing cyanide, but this has been disputed in a recent study. It also is not very effective in adsorbing alcohols, ferrous sulfate, caustic alkalies, nitrates, sodium chloride/chlorate, petroleum distillates or mineral acids. Uses/Indications - Activated charcoal is administered orally to adsorb certain drugs or toxins to prevent or reduce their systemic absorption.
Activated charcoal is not absorbed nor metabolized in the gut.
Contraindications/Precautions/Reproductive Safety - Charcoal should not be used for mineral acids or caustic alkalies as it is ineffective. Although not contraindicated for ethanol, methanol, or iron salts, activated charcoal is not very effective in adsorbing these products and may obscure GI lesions during endoscopy.
Dogs & Cats:
a) 1 gram/5 ml of water; give 10 ml of slurry per kg PO. (Morgan 1988)
b) For acute poisoning: 2 - 8 g/kg PO once or every 6-8h for 3-5 doses. To enhance excretion of slowly excreted poisons: 0.5 g/kg PO q3h for about 72 hours. (Mount 1989)
c) 1 - 4 g/kg in 50 - 200 ml of water. Concurrent with or within 30 minutes of giving charcoal, give an osmotic cathartic. Repeated doses of activated charcoal may also bind drugs that are enterohepatically recycled. (Beasley and Dorman 1990)
d) Administer in a bathtub or other easily cleanable area. Give activated charcoal at 1 – 5 g/kg PO (via stomach tube using either a funnel or large syringe) diluted in water at a concentration of 1 g charcoal/5-10 ml of water. Follow in 30 minutes with sodium sulfate oral cathartic. (Bailey 1989)
a) 1 - 3 grams/kg PO (1 gram of charcoal in 3-5 ml of water) via stomach tube; give saline cathartic concurrently. May repeat in 8-12 hours. (Bailey 1986b)
a) Foals: 250 grams (minimum). Adult horses: up to 750 grams. Make a slurry by mixing with up to 4 L (depending on animalÕs size) of warm water and administer via stomach tube. Leave in stomach for 20-30 minutes and then give a laxative to hasten removal of toxicants. (Oehme 1987b)
Monitoring Parameters - Monitoring for efficacy of charcoal is usually dependent upon the toxin/drug that it is being used for and could include the drug/toxinÕs serum level, clinical signs, etc.
Client Information - This agent should usually be used with professional supervision, depending on the potential severity of the toxin/overdose. Charcoal can be very staining to fabrics.
Dosage Forms/Preparations/FDAApproval Status/Withholding -Times:
Activated charcoal 47.5%, Kaolin 10% granules (free flowing and wettable) in 1 lb bottles, and 5kg pails Toxiban¨ Granules (Vet-A-Mix); (OTC) Indicated for use in both large and small animals Activated charcoal 10.4%, Kaolin 6.25% suspension in 240 ml bottles Toxiban¨ Suspension (Vet-A-Mix); (OTC) Indicated for use in both large and small animals.
Activated Charcoal Aqueous Suspension 50 g in unit dose tube Liqui-Char-Vet Aqueous Suspension¨ (Daniels); (OTC)
Activated Charcoal Powder in 15, 30, 40 , 120 , 240 g & UD 30 g (Activated charcoal is also available in bulk powder form); Generic, (OTC)
Activated Charcoal Suspension; 25 g in 120 ml bottles, and 50 g in 240 ml bottles;
Aqua¨ (Paddock) ; (OTC)
Activated Charcoal Suspension with sorbitol; 15 g in 120 ml bottles 25 g in 120 ml bottles, 30 g in 150 ml bottles, and 50 g in 240 ml bottles; Actidose with Sorbitol¨ (Paddock),CharcoAid¨
Activated Charcoal Liquid 15 g & 50g with & without sorbitol in 120 ml and 240 ml bottles,12.5 g in propylene glycol 60 ml bottles, and 25 g in propylene glycol 120 ml bottles;
CharcoAid 2000 ¨ (Requa) (OTC) Generic; (OTC) Activated Charcoal Liquid; 12.5 g in 60 ml bottles, 15 g in 75 ml bottles, 25 g in 120 ml bottles,30 g in 120 ml bottles, & 50 g in 240 ml bottles; Liqui-Char¨ (Jones Medical); (OTC)
Activated Charcoal Granules 15 g in 120 ml bottles; CharcoAid 2000¨ (Requa) (OTC)
-Adverse Effects/Warnings :
Very rapid GI administration of charcoal can induce emesis. Charcoal can cause either constipation or diarrhea and feces will be black. Products containing sorbitol may cause loose stools and vomiting. Charcoal powder is very staining and the dry powder tends to float covering wide areas.
-Overdosage/Acute Toxicity :
None reported when used for acute therapy; see Adverse Effects above for more information.
Separate by at least 3 hours administration of any other orally administered therapeutic agents from the charcoal dose. Charcoal should not be administered with dairy products or mineral oil as the adsorptive properties of the charcoal will be diminished. Do not administer (at the same time) with syrup of ipecac as the charcoal can adsorb the ipecac and reduce its efficacy
Store activated charcoal in well-closed glass or metal containers or in the manufacturerÕs supplied container