From the Guidelines
Activated charcoal is effective for treating poisonings from many medications and toxins, including acetaminophen, when administered within 1-2 hours of ingestion, as evidenced by the most recent study 1.
Key Points
- Activated charcoal works best for drugs like acetaminophen, aspirin, tricyclic antidepressants, benzodiazepines, barbiturates, carbamazepine, phenytoin, theophylline, digoxin, and many antipsychotics.
- It's also useful for treating poisonings from certain pesticides, herbicides, and some household chemicals.
- The typical adult dose is 50-100 grams (25-50 grams for children), usually given as a slurry mixed with water.
- Activated charcoal works by binding to toxins in the gastrointestinal tract, preventing their absorption into the bloodstream.
- However, it's not effective for all poisonings - it doesn't work well for alcohols, strong acids or bases, lithium, iron, potassium, lead, or petroleum products.
- It should be administered as soon as possible after poisoning, ideally within an hour, though it may still provide benefit up to 4 hours post-ingestion for some substances, as suggested by 1.
- Multiple doses may be needed for drugs that undergo enterohepatic circulation.
- Activated charcoal should only be given to alert patients who can protect their airway, as aspiration is a serious risk.
Specific Considerations
- For acetaminophen poisoning, activated charcoal may be useful for gastrointestinal decontamination if given within a few hours of presentation, as stated in 1.
- The use of activated charcoal in other types of poisonings, such as beta-adrenergic antagonists, is also supported by recent studies 1.
- However, the effectiveness of activated charcoal in cardiac arrest due to toxic ingestions is still a topic of debate, and further research is needed to validate its use in these situations, as noted in 1.
From the FDA Drug Label
2 In the case of a mixed drug overdose activated charcoal may be indicated.
- Activated charcoal may be used to treat mixed drug overdose toxicity.
- The use of activated charcoal is specifically mentioned in the context of a mixed drug overdose, implying its potential effectiveness in such cases. 2
From the Research
Poisons or Drugs Toxicity Treated with Activated Charcoal
- Activated charcoal can adsorb a wide variety of drugs and chemicals, including acetaminophen 3, 4, 5, 6
- It is effective in preventing the gastrointestinal absorption of most drugs and toxins, with exceptions including alcohols, cyanide, and metals such as iron and lithium 4
- Repeated dosing with oral activated charcoal can enhance the elimination of many toxicologically significant agents, such as:
- Aspirin
- Carbamazepine
- Dapsone
- Dextropropoxyphene
- Cardiac glycosides
- Meprobamate
- Phenobarbitone
- Phenytoin
- Theophylline 4
- Activated charcoal can also accelerate the elimination of many industrial and environmental intoxicants 4
- In acute intoxications, 50 to 100g of activated charcoal should be administered to adult patients as soon as possible, with exceptions including patients poisoned with caustic alkalis or acids 4
- The use of activated charcoal in combination with N-acetylcysteine may provide additional hepatoprotective benefit in the treatment of acetaminophen overdoses 5, 6