Canadian antidote guide

Activated Charcoal

• Active carbon
• Activated carbon
• Active charcoal
• Charac™
• Charac-tol™
• Charcodote™

Preventing Absorption

• Consider administering a single dose of activated charcoal in these cases:
  • Potentially toxic ingestion occurring less than one hour ago*
  • If no contraindications are present (e.g., unprotected airway, GCS less than 15, intestinal obstruction, ingestion of a corrosive agent or aliphatic hydrocarbon).

*If the patient has ingested an agent that slows gastric emptying (e.g. anticholinergic, opioid), a salicylate, an extended-release or enteric-coated substance, a significant amount of toxic substance or if there is evidence of bezoars, the administration of activated charcoal could be considered more than one hour post-ingestion and could even be repeated. Consult your poison centre.

• Gastric distension, constipation, vomiting
• Black stool
• Aspiration that may be complicated by respiration failure

• Check regularly that the airway is protected.
• Check regularly on the presence of peristalsis.

• After one dose in the majority of cases.
• If onset of contraindication (e.g, impaired peristalsis, unprotected airway).
• If the toxic concentration is no longer worrisome.
• In other situations, if the clinical progression suggests that the poisoning is resolved.

Enteral Route

• Vigorously shake the suspension before administration.
• Administer slowly over a period of 15 minutes to minimize gastric distention and subsequent vomiting.
• The dose of activated charcoal can be divided in order to improve its tolerance.
  • PO
    • Cut the tip of the bottle and insert a straw.
    • Palatability: Activated charcoal has a grainy texture that can give it an unpleasant taste and make it difficult to swallow. Adding a flavouring agent (regular cola, cherry syrup) just before administration to patients - particularly pediatric patients - can improve taste and acceptability.
      • Volume ratio of activated charcoal: cola of 1:1
      • Volume ratio of activated charcoal: cherry syrup of 6:1
    • Putting the activated charcoal in an opaque, colourful bottle with a straw may also help improve acceptability in pediatric patients.
  • Nasogastric Tube
    • Cut the tip of the bottle and insert the end of the probe inside. Gently squeeze the bottle to empty to content into the gastric tube.
    • Rinse the content of the tube with 5 to 10 ml of sterile water for injection, then clamp the tube for a period of 1 to 2 hours.

Reconstitution

• Activated charcoal that is not an oral suspension can be diluted in water or cola to obtain an activated charcoal: fluid ratio of 1:5.

Compatibility

• Activated charcoal may reduce the absorption of many drugs co-administered by enteral or even parenteral route.

Stability

• Store product at room temperature.

• Charac - 25 PED, 222 mg/ml, oral susp.,112.5 ml (25 g), Omega, DIN 02056429, 
• Charac - 50, 222 mg/ml, oral susp, 225 ml (50 g), Omega, DIN 00637955, 
• Charactol - 25, 200 mg/ml, oral susp, 125ml (25 g), Oméga, DIN 02060205
• Charactol - 50, 200mg/ml, oral susp, 250ml (50g), Oméga, DIN 00649236
• Activated charcoal USP, Pd. (454 g), Galenova. 

• At least 300 g.

Chan, Betty S. H., Kate Sellors, Angela L. Chiew, and Nicholas A. Buckley. 2015. “Use of Multi-Dose Activated Charcoal in Phenytoin Toxicity Secondary to Genetic Polymorphism.” Clinical Toxicology 53 (2):131–33.



Cheng, Adam, and Savithiri Ratnapalan. 2007. “Improving the Palatability of Activated Charcoal in Pediatric Patients.” Pediatric Emergency Care 23 (6):384–86.



Chyka, P. A., D. Seger, E. P. Krenzelok, J. A. Vale, American Academy of Clinical, Toxicology, European Association of Poisons, Centres, and Clinical, Toxicologists. 2005. “Position Paper: Single-Dose Activated Charcoal.” Clinical Toxicology 43 (2):61–87.



Dagnone, Damon, Doreen Matsui, and Michael J. Rieder. 2002. “Assessment of the Palatability of Vehicles for Activated Charcoal in Pediatric Volunteers.” Pediatric Emergency Care 18 (1):19–21.



Guenther Skokan, E., E. P. Junkins Jr, H. M. Corneli, and J. E. Schunk. 2001. “Taste Test: Children Rate Flavoring Agents Used with Activated Charcoal.” Archives of Pediatrics & Adolescent Medicine 155 (6):683–86.



Juurlink, David N. 2016. “Activated Charcoal for Acute Overdose: A Reappraisal.” British Journal of Clinical Pharmacology 81 (3):482–87.



“Position Statement and Practice Guidelines on the Use of Multi-Dose Activated Charcoal in the Treatment of Acute Poisoning. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists.” 1999. Journal of Toxicology. Clinical Toxicology 37 (6):731-51