Activated charcoal (medication)
Activated charcoal for medical use
|Trade names||CharcoAid, others|
|by mouth, nasogastric tube|
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. 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 most effective and safe medicines needed in a health system. The wholesale costs in the developing world is between 0.46 and 0.86 USD per dose. In the United States a course of treatment costs less than 25 USD.
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.
There are no randomized controlled trials that it 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.
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
Active charcoal binds the poison and prevents its absorption by the gastrointestinal tract. 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.
Mechanisms of action:
- Binding of the poison to prevent stomach and intestinal absorption. Binding is reversible so a cathartic such as sorbitol may be added as well.
- It interrupts the enterohepatic and enteroenteric circulation of some drugs/toxins and their metabolites.
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