Activated charcoal (medication)

Activated charcoal for medical use

Activated charcoal, or activated carbon, is used as a medication to treat poisonings following excessive oral ingestion of certain medications or poisons. Side effects may include aspiration into the lungs.

It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system. It costs wholesale between 0.01 and 0.02 USD per 125 mg pill.

Medical uses

Poison ingestion

Activated charcoal is used to treat many types of oral poisonings. 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.

Gastrointestinal tract-related issues

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

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.

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. 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.