Activated charcoal (medication)

Activated charcoal
Activated charcoal for medical use
Clinical data
Trade names CharcoAid, others
AHFS/Drugs.com Monograph
Routes of
administration		 by mouth, nasogastric tube
Identifiers
CAS Number
ChemSpider
  • none
ECHA InfoCard 100.036.697 Edit this at Wikidata

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.[2][1] 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]

Common side effects include vomiting, black stools, diarrhea, and constipation.[1] The more serious side effect, pneumonitis, may result if aspirated into the lungs.[2][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 0.46 and 0.86 USD per dose.[7] In the United States a course of treatment costs less than 25 USD.[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.

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.[14] 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. 1 2 3 4 5 6 "Charcoal, Activated". The American Society of Health-System Pharmacists. Archived from the original on 21 December 2016. Retrieved 8 December 2016.
  2. 1 2 3 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. 1 2 3 Hamilton, Richart (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 469. ISBN 9781284057560.
  4. ↑ Cecen, Ferhan; Aktas, Özgür. "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. 1 2 3 "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. ↑ 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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