Activated charcoal (medication)

Activated charcoal, also known as activated carbon, is a medication used to treat poisonings that occurred by mouth.[1] To be effective it must be used within a short time of the poisoning occurring, typically an hour.[1][2] It does not work for poisonings by cyanide, corrosive agents, iron, lithium, alcohols, or malathion.[2] It may be taken by mouth or given by a nasogastric tube.[3] Other uses include inside hemoperfusion machines.[1]

Main article: Activated carbon
Activated charcoal
Activated charcoal for medical use
Clinical data
Trade namesCharcoAid, others
AHFS/Drugs.comMonograph
Routes of
administration		by mouth, nasogastric tube
Identifiers
CAS Number
ChemSpider
  • none
CompTox Dashboard (EPA)
ECHA InfoCard100.036.697

Common side effects include vomiting, black stools, diarrhea, and constipation.[1] The more serious side effect, pneumonitis, may result if aspirated into the lungs.[1][2] Gastrointestinal obstruction and ileus are less common but serious adverse effects.[1] Use in pregnancy and breastfeeding is safe.[3] Activated charcoal works by adsorbing the toxin.[1]

While charcoal has been used since ancient times for poisonings, activated charcoal has been used since the 1900s.[4][5] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[6] The wholesale costs in the developing world is between US$0.46 and US$0.86 per dose.[7] In the United States a course of treatment costs less than US$25.[3]

Medical uses

Poison ingestion

Activated charcoal is used to treat many types of oral poisonings such as phenobarbital and carbamazepine.[8] It is not effective for a number of poisonings including: strong acids or bases, iron, lithium, arsenic, methanol, ethanol or ethylene glycol.[8]

No randomized controlled trials have shown activated charcoal improves outcomes and routine use is not recommended.[8] In a study of acute poisonings from agricultural pesticides and yellow oleander seeds, the administration of activated carbon did not affect survival rates.[9]

Charcoal biscuits were sold in England starting in the early 19th century, originally as remedy to flatulence and stomach trouble.[10]

Tablets or capsules of activated carbon are used in many countries as an over-the-counter drug to treat diarrhea, indigestion, and flatulence.[11] There is some evidence of its effectiveness to prevent diarrhea in cancer patients who have received irinotecan.[12] It can interfere with the absorption of some medications, and lead to unreliable readings in medical tests such as the guaiac card test.[13] 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.

Other

Claims that activated charcoal will do things such as whiten teeth, cure alcohol-induced hangovers, and prevent bloating, are not supported by evidence.[14][15] Activated charcoal cleanses also lack evidence and are considered pseudoscience.[16]

Side effects

Incorrect application (e.g. into the lungs) results in pulmonary aspiration which can sometimes be fatal if immediate medical treatment is not initiated.[17] 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.

References
  1. "Charcoal, Activated". The American Society of Health-System Pharmacists. Archived from the original on 21 December 2016. Retrieved 8 December 2016.
  2. WHO Model Formulary 2008 (PDF). World Health Organization. 2009. p. 57. ISBN 9789241547659. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016.
  3. Hamilton, Richart (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 469. ISBN 9781284057560.
  4. Cecen, Ferhan; Aktas, Özgür (2011-09-19). "1". Activated Carbon for Water and Wastewater Treatment: Integration of Adsorption and Biological Treatment. John Wiley & Sons. ISBN 9783527639458. Archived from the original on 2016-12-20.
  5. Tascón, J. M. D. (2012). Novel Carbon Adsorbents. Elsevier. p. 640. ISBN 9780080977447. Archived from the original on 2016-12-20.
  6. "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016.
  7. "Charcoal, Activated". International Drug Price Indicator Guide. Retrieved 13 August 2015.
  8. "Charcoal, Activated". The American Society of Health-System Pharmacists. Archived from the original on 22 May 2014. Retrieved 23 April 2014.
  9. Eddleston M, Juszczak E, Buckley NA, et al. (2008). "Multiple-dose activated charcoal in acute self-poisoning: a randomised controlled trial". Lancet. 371 (9612): 579–87. doi:10.1016/S0140-6736(08)60270-6. PMC 2430417. PMID 18280328.
  10. Rolland, Jacques L. (2006). The Food Encyclopedia: Over 8,000 Ingredients, Tools, Techniques and People. Robert Rose. p. 148. ISBN 0-7788-0150-0.
  11. Stearn, Margaret (2007). Warts and all: straight talking advice on life's embarrassing problems. London: Murdoch Books. p. 333. ISBN 978-1-921259-84-5. Archived from the original on 2017-09-10. Retrieved 2009-05-03.
  12. Michael M, Brittain M, Nagai J, et al. (Nov 2004). "Phase II study of activated charcoal to prevent irinotecan-induced diarrhea". J Clin Oncol. 22 (21): 4410–7. doi:10.1200/JCO.2004.11.125. PMID 15514383.
  13. Gogel HK, Tandberg D, Strickland RG (Sep 1989). "Substances that interfere with guaiac card tests: implications for gastric aspirate testing". Am J Emerg Med. 7 (5): 474–80. doi:10.1016/0735-6757(89)90248-9. PMID 2787993.
  14. Brooks, JK; Bashirelahi, N; Reynolds, MA (September 2017). "Charcoal and charcoal-based dentifrices: A literature review". Journal of the American Dental Association (1939). 148 (9): 661–670. doi:10.1016/j.adaj.2017.05.001. PMID 28599961.
  15. "Can activated charcoal help with hangovers?". WebMD. Retrieved 13 March 2019.
  16. Medlin, Sophie (12 June 2018). "Activated charcoal doesn't detox the body – four reasons you should avoid it". The Conversation. Archived from the original on 13 June 2018. Retrieved 26 November 2019.
  17. Elliott C, Colby T, Kelly T, Hicks H (1989). "Charcoal lung. Bronchiolitis obliterans after aspiration of activated charcoal". Chest. 96 (3): 672–4. doi:10.1378/chest.96.3.672. PMID 2766830.
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