General

Trade Name(s)

• Acta-Char Liquid-A

• Actidose-Aqua

• Aqueous Charcodote [Canada]

• Charac-50 [Canada]

• CharcoAid 2000

• Charcodote [Canada]

• Insta-Char

• Insta-Char Aqueous Suspension

• Liqui-Char

• SuperChar Aqueous

Pregnancy Category
Category C

Ther. class.
antidotes

Pharm. class.
adsorbents

Indications

Acute management of many oral poisonings following emesis/lavage

Action

Binds drugs and chemicals in the GI tract

Therapeutic Effect(s):
Decreased intestinal absorption of drugs or chemicals in the overdose situation

Pharmacokinetics

Absorption: None

Distribution: None

Metabolism and Excretion: Excreted unchanged in the feces

Half-life: Unknown

TIME/ACTION PROFILE (antidote)

ROUTE	ONSET	PEAK	DURATION
PO	within min	unknown	4–12 hr

Contraindication/Precautions

Contraindicated in:
No known contraindications

Use Cautiously in:

• Poisonings due to cyanide, corrosives, ethanol, methanol, petroleum distillates, organic solvents, mineral acids, or iron

• Endoscopic examination (observation will be obscured)

Adverse Reactions/Side Effects

GI: black stools, constipation, diarrhea, vomiting.

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

Interactions

Drug-Drug
Other drugs including ipecac syrup and laxatives will be adsorbed by charcoal and as a result will not be systemically absorbed from the GI tract

Drug-Food
Milk, ice cream, or sherbet will decrease the ability of charcoal to absorb other agents

Route/Dosage

Antidote

• PO (Adults): 25–100 g (may be repeated q 4–6 hr).

• PO (Children 1–12 yr): 25–50 g (may be repeated q 4–6 hr).

• PO (Children <1 yr): 1 g/kg (may be repeated q 4–6 hr).

Availability

• Powder: 15-, 25- 30-[canada], 40-, 120-, 125-g 240-g^OTC containers

• Oral suspension: 12.5 g/60 ml^OTC, 15 g/72 ml^OTC, 15 g/120 ml^OTC, 25 g/120 ml^OTC, 30 g/120 ml^OTC, 50 g/240 ml^OTC, 15 g/120 ml^OTC, 25 g/125 ml^OTC, 50 g/225 ml^OTC, 50 g/250 ml^OTC

• In combination with: sorbitol (Actidose with Sorbitol), Charcoaid, Pediatric Charcodote[canada], Charac-tol[canada], (Charcodote TFS)^OTC[canada]

Assessment

• Assess neurologic status; administer only if patient is alert (unless airway is protected)

• Inquire as to the type of drug or poison and time of ingestion

• Consult reference, poison control center, or physician for symptoms of toxicity of ingested agent(s)

• Monitor blood pressure, pulse, respiratory and neurologic status, and urine output as indicated by toxicity of agent(s). Notify physician if symptoms persist or worsen

Lab Test Considerations

• Chronic use may impair absorption of essential nutrients. This may result in decreased mineral or electrolyte levels

Potential Nursing Diagnoses

• Risk for self-directed violence (Indications)

• Risk for injury (Indications)

Implementation

• Treatment of Poisoning: Activated charcoal is most effective if administered within 30 min of ingestion of drug or poison. Dosage may be repeated for drugs subjected to enterohepatic elimination to minimize further absorption

» If syrup of ipecac is used, administer ipecac first and wait until emesis occurs before administering activated charcoal

• PO: Mix dose in 6–8 oz water; administer as a slurry (unless using suspension with or without sorbitol). Do not administer with milk products (milk, ice cream, or sherbet). May need to be diluted with additional water to be thin enough to administer through a nasogastric tube

» Shake oral suspension well before administration

» Rapid ingestion may cause vomiting. If vomiting occurs shortly after administering dose, confer with physician about repeating dose

» Do not administer other oral drugs for 2 hr before or after administering activated charcoal

» Slurry is constipating; physician may order a laxative to speed removal of the drug. May not be required with products containing sorbitol

Patient/Family Teaching

• Inform patient that stools will turn black

• Poisoning: When counseling, discuss methods of prevention, need to confer with poison control center, physician, or emergency department before administering, and need to bring ingested substance to emergency department for identification

Evaluation/Desired Outcomes

Prevention or resolution of toxic effects of ingested agent

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