activated charcoal (OTC)

Overdose, Poisoning

1 g/kg, 25-100 g PO

Alternatively 10 g charcoal/1 g drug ratio

Minimum dose = 25 g

Commonly used with sorbitol 25 g; multiple dose regimen 25 g PO q2hr or 50 g q4hr without sorbitol

DO NOT give sorbitol after first dose due to risk for severe diarrhea; use aqueous solution

Dose cathartic once daily if used

Shake vigorously prior to use

Administer in closed container with straw; may place on ice to improve taste; mix 1:3 soda for pediatrics

Multiple doses used with dapsone, carbamazepine, digitoxin and digoxin, phenobarbital, theophylline, meprobamate, quinine

Poisoning

Aqueous suspension

• Infants: 1 g/kg/ dose PO; may repeat q4-6hr
• Children: 1-2 g/kg/dose (or 25-50 g/dose) PO; may repeat q4-6hr
• Adolescents: 5-10 times the estimated weight of drug/chemical ingested (or 50-100 g/dose) PO; may repeat q4-6hr

Sorbitol suspension

• Infants and children: Not indicated; due to risk for severe diarrhea associated with sorbitol suspension, the aqueous formulation is recommended
• Adolescents: 50 g as a single dose PO; not recommended for multiple dosage regimens (use aqueous solutions for repeat dosing)

Contraindicated (0)

Serious - Use Alternative (0)

Monitor Closely (6)

• acetylcysteine

  activated charcoal decreases effects of acetylcysteine by Other (see comment). Use Caution/Monitor. Comment: Conflicting reports exist; however, charcoal administration does not preclude acetylcysteine administration for acetaminophen overdose .

• acetylcysteine (Antidote)

  activated charcoal decreases effects of acetylcysteine (Antidote) by Other (see comment). Use Caution/Monitor. Comment: Conflicting reports exist; however, charcoal administration does not preclude acetylcysteine administration for acetaminophen overdose .

• citalopram

  activated charcoal decreases effects of citalopram by pharmacodynamic antagonism. Use Caution/Monitor. Charcoal can reduce absorption of citalopram, resulting in decreased efficacy.

• digoxin

  activated charcoal decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• methotrexate

  activated charcoal will decrease the level or effect of methotrexate by Other (see comment). Use Caution/Monitor. Charcoal can reduce absorption of methotrexate and remove it from systemic circulation. Depending on the clinical situation, this will reduce the effectiveness or toxicity of methotrexate.

• theophylline

  activated charcoal decreases levels of theophylline by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

Minor (3)

• acarbose

  activated charcoal decreases levels of acarbose by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• leflunomide

  activated charcoal decreases levels of leflunomide by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• miglitol

  activated charcoal decreases levels of miglitol by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• acarbose

  Minor (1)activated charcoal decreases levels of acarbose by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• acetylcysteine

  Monitor Closely (1)activated charcoal decreases effects of acetylcysteine by Other (see comment). Use Caution/Monitor. Comment: Conflicting reports exist; however, charcoal administration does not preclude acetylcysteine administration for acetaminophen overdose .

• acetylcysteine (Antidote)

  Monitor Closely (1)activated charcoal decreases effects of acetylcysteine (Antidote) by Other (see comment). Use Caution/Monitor. Comment: Conflicting reports exist; however, charcoal administration does not preclude acetylcysteine administration for acetaminophen overdose .

• citalopram

  Monitor Closely (1)activated charcoal decreases effects of citalopram by pharmacodynamic antagonism. Use Caution/Monitor. Charcoal can reduce absorption of citalopram, resulting in decreased efficacy.

• digoxin

  Monitor Closely (1)activated charcoal decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

• leflunomide

  Minor (1)activated charcoal decreases levels of leflunomide by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• methotrexate

  Monitor Closely (1)activated charcoal will decrease the level or effect of methotrexate by Other (see comment). Use Caution/Monitor. Charcoal can reduce absorption of methotrexate and remove it from systemic circulation. Depending on the clinical situation, this will reduce the effectiveness or toxicity of methotrexate.

• miglitol

  Minor (1)activated charcoal decreases levels of miglitol by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• theophylline

  Monitor Closely (1)activated charcoal decreases levels of theophylline by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.