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Activated charcoal

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Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • AC, Acta-Char®, Actidose®, Actidose AquaT, activated carbon, activated carbon nanoparticles adsorbing mitomycin C (MMC-ACNP), activated coal, Adsorba®, animal charcoal, Arm-a-char®, AST-120, carbo (Latin), Carbomix®, Carbomix® BP, carbon, Carbosorb® X, carvão vegetal (Portuguese), charbon de bois (French), CharcoAid®, charcoal, Charcocaps®, Charcodote®, CharcotraceT, chitosan encapsulated activated charcoal beads (ACCB), CHR-30, drevené uhlí (Czech), EZ-CharT, gas black, gastrointestinal decontamination agent, Holzkohle (German), Insta-Char®, Kremezin®, lamp black, Liqui-Char®, Medicoal®, Merckmezin®, mitomycin C bound to activated carbon particles (MMC-AC or MMC-CH), multiple-dose activated charcoal (MDAC), Norit® A Supra, Norit® C, Norit® C Extra, Nuchar®, oral activated charcoal (OAC), SIAX, silver-impregnated activated charcoal, single-dose activated charcoal (SDAC), Super-Char®, superactivated charcoal, trækul (Danish), trekull (Norwegian), viðarkol (Icelandic).
  • Select combination products: Carbosylane® (simethicone and activated charcoal); Carbosymag® (simethicone, activated charcoal, and magnesium oxide); Carbosorb® XS (50g of activated charcoal and 100g of sorbitol in 250mL); Actisorb® Silver 220 (silver-impregnated activated charcoal dressing).

Background
  • Activated charcoal is a carbon-rich material that has been processed to have an increased surface area. Activated charcoal is widely used for treating drug overdoses and poisonings.
  • Activated charcoal is most effective if used within one hour of ingesting toxic substances. It has proven to be effective in both adult and child overdoses of drugs such as acetaminophen, digoxin, digitoxin, tricyclic antidepressants, and barbiturates. However, activated charcoal is not effective in poisonings caused by strong acids or bases, cyanide, organic solvents, ethanol, methanol, iron, or lithium, among other substances.
  • Activated charcoal has been traditionally given with laxatives to encourage removal of toxic contents and improve tolerance to charcoal. However, in 2004 and 1997, the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists stated that they do not endorse the combination of activated charcoal with a laxative. This combination may cause serious side effects such as dehydration, electrolyte imbalances, and low blood pressure.
  • Activated charcoal has been studied for many stomach disorders, including diarrhea, gas, and indigestion. Research suggests that activated charcoal may benefit people who have diarrhea caused by chemotherapy. When combined with simethicone, activated charcoal may improve symptoms of indigestion. Activated charcoal may also improve bloating and stomach cramps and prevent gas.
  • Due to its adsorbing effects (attracts substances to the surface of the material), activated charcoal may help treat liver and kidney disorders. Taking activated charcoal by mouth may lower cholesterol levels and reduce high levels of bile acids. Charcoal may also be given with light therapy to help prevent jaundice (yellowing of the skin) in newborn babies.
  • Activated charcoal particles have been studied as a drug delivery system to improve effectiveness of therapies and reduce chemotherapy agent side effects. However, more research is needed in this area.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Activated charcoal has strong adsorbent properties. It is most effective when given within one hour after ingestion of toxic substances. Activated charcoal has been traditionally given with laxatives such as sorbitol or magnesium citrate. However, the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists have stated that they do not endorse this combination.

A


Research suggests that activated charcoal may benefit people who have diarrhea. However, it is not considered standard care for nonspecific diarrhea. Studies report that activated charcoal may be effective in preventing diarrhea in people undergoing chemotherapy. Experts warn against using activated charcoal with other agents used to treat diarrhea.

B


Itchy skin may be caused by advanced chronic kidney failure and dialysis. Research suggests that activated charcoal may benefit people with this condition. The reasons for this benefit are not well understood. However, experts suggest that activated charcoal may adsorb a compound that causes the itching.

B


Studies suggest that high levels of bile acids may lead to bile flow problems in pregnancy. Early evidence shows that activated charcoal may be effective in preventing this condition. However, more research is needed in this area.

C


Anticancer drugs have been found to be unsuccessful in reducing secondary cancer development in people who have had stomach cancer surgery. Early research suggests that chemotherapy with mitomycin C adsorbed onto activated charcoal (MMC-CH) may help increase survival rates after stomach cancer surgery. However, more research is needed in this area.

C


Some studies suggest that activated charcoal may adsorb gas. However, results are inconsistent. More research is needed in this area.

C


Early research reports that activated charcoal may lower cholesterol levels. More research is needed in this area.

C


Early research suggests that activated charcoal plus simethicone (with or without magnesium oxide) may reduce indigestion symptoms. More research is needed on the potential effects of activated charcoal alone.

C


Research shows that activated charcoal may help reduce nitrogen-containing waste products. A low-protein diet combined with activated charcoal has been found to benefit elderly people who have advanced kidney disease. Other research found that Kremezin®, an activated charcoal formula sold in Japan, may have more benefit for kidney function than Merckmezin®, another product available in Japan. More research is needed in this area.

C


High levels of bilirubin, a compound found in the bile, may lead to jaundice (yellowing of the skin) in newborn babies. Light therapy is the most common treatment for this condition. Early evidence suggests that activated charcoal may help increase the effects of light therapy. Additional research is needed in this area.

C


Evidence suggests that activated charcoal dressings that contain silver may help decrease bacteria and speed healing time. This therapy may have greater benefit than some ointments or zinc paste. Additional research is needed in this area.

C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Aging, asthma, blood disorders, blood purifier, bronchial asthma, deodorant, disease diagnosis, inflammatory skin conditions, irritable bowel syndrome, liver disorders, metabolic disorders, ulcerative colitis.

Dosing

Adults (18 years and older)

  • Note: A single dose of activated charcoal with a cathartic (e.g., sorbitol, magnesium citrate) within one hour of oral toxin ingestion has been traditionally used. However, in 2004 and 1997, position statements from the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists stated that the combination of activated charcoal with a cathartic is not endorsed. This group of experts also cautioned against the use of ipecac with activated charcoal, as this may reduce its effectiveness.
  • Multiple-dose activated charcoal may be called for in certain circumstances, but only if a patient has ingested a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine, or theophylline.
  • A limitation of the use of activated charcoal is its taste and texture. It has been described as a gritty and unpleasant black liquid and may cause vomiting. Yogurt has been used to improve the taste and texture of activated charcoal; however, some research has shown that mixing activated charcoal with yogurt instead of water prolonged ingestion time but did not improve the palatability in adults. In other research, a formulation of activated charcoal, CharcoAid®, was found to be more palatable than an older nongranulated formulation and may improve patient compliance.
  • To treat bile flow problems in pregnancy, 50 grams of activated charcoal has been taken by mouth three times daily for eight days.
  • To prevent or treat diarrhea caused by chemotherapy, 1,000 milligrams of activated charcoal (Charcodote®, Pharmascience, Montreal, Canada) has been taken by mouth before chemotherapy and three times daily for 48 hours after chemotherapy (at three different dose levels: dose level 1 being 30 milliliters of diluted solution (1,000 milligrams of Charcodote® in 25 milliliters of water); dose level 2 being 60 milliliters of diluted solution(2,000 milligrams of Charcodote® in 50 milliliters of water); and dose level 3 being 90 milliliters of diluted solution (3,000 milligrams of Charcodote® in 75 milliliters of water).
  • To reduce gas, 260 milligrams of activated charcoal has been taken by mouth after ingestion of lactulose (performed twice). Three capsules of 194 milligrams of activated charcoal have been taken by mouth immediately after a gas-producing meal, followed by the same dose given two hours after the first. Three capsules of activated charcoal have been taken by mouth immediately after a gas-producing meal, followed by three additional capsules at 30-minute intervals until a total of 15 capsules were taken.
  • To treat high cholesterol, 15-30 grams of activated charcoal have been taken by mouth in divided doses for up to 12 weeks. A dose of 20 grams of superactivated charcoal has been taken by mouth twice daily.
  • To treat poisoning, an adult dose of activated charcoal of 50-100 grams has been taken by mouth as a single dose or multiple doses. Activated charcoal has been taken by mouth in a ratio of at least 10:1 (charcoal:toxin) by weight. Lower doses of 10-25 grams have been taken by mouth. In acute drug poisoning, the following doses have been taken by mouth: an initial dose of 50-100 grams, followed by one of the following schedules: 12.5 grams every hour, 25 grams every two hours, or 50 grams every four hours. Multiple doses of activated charcoal have been taken by mouth to enhance effects. The American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists state that multiple doses should only be used in cases of ingestion of a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine, or theophylline.
  • Note: Vomiting is considered a common problem after taking activated charcoal by mouth for ingested poisons. Agents that treat nausea and vomiting may be given.
  • Charcoal hemoperfusion (a technique in which blood passes through a column with activated charcoal to remove toxic substances) has been used.
  • To treat itchy skin in people with kidney disorders, six grams of activated charcoal has been taken by mouth daily for up to eight weeks.
  • To promote wound healing, activated charcoal dressings that contain silver have been applied to the skin. The product Actisorb® Silver 220 has been applied to the skin and may also be covered with a bandage and left for up to seven days.
  • As an additional therapy for cancer, 50 milligrams of mitomycin adsorbed onto activated charcoal has been delivered into the stomach cavity.

Children (under 18 years old)

  • Note: Compliance with charcoal therapy is an issue in children. Controversy exists whether mixing activated charcoal with liquids such as cola beverages, chocolate milk, cherry syrup, or orange juice improves compliance. In children, it is often necessary to give activated charcoal through a tube into the stomach. It has been suggested that activated charcoal should not be taken for more than 3-4 days, as it may cause nutrient depletion.
  • To treat diarrhea caused by chemotherapy in children aged 1-18 years, 250 milligrams of activated charcoal has been taken by mouth the evening before treatment and continued every eight hours until the end of treatment.
  • As an additional therapy for newborn jaundice (yellowing of the skin), 10 milliliters of activated charcoal (Super-Char® Aqueous, containing 1.3 grams of activated charcoal per dose) has been taken by mouth with 1.5 milliliters of dextrose 10% solution, 10 minutes before each meal along with light therapy. A dose of 7.5 milliliters of activated charcoal (Super-Char® Aqueous, containing 0.98 grams of activated charcoal per dose), with one milliliter of dextrose 10% solution, has been taken by mouth 10 minutes before each meal with light therapy. A range of 5-14 doses of activated charcoal has been taken by mouth.
  • To treat poisoning in children up to one year of age, 10-25 grams or 0.5-1 gram per kilogram has been taken by mouth. In children 1-12 years of age, 25-50 grams or 0.5-1 gram per kilogram has been taken by mouth. In adolescents, 25-100 grams has been taken by mouth. Multiple doses of activated charcoal may be given in cases of ingesting carbamazepine, dapsone, phenobarbital, quinine, or theophylline; however, an appropriate dose has not been established. In adolescents who ingested a toxic amount of theophylline, activated charcoal has been given through a nasal tube. A dose of 20-50 grams of activated charcoal, followed by activated charcoal diluted in 0.9% sodium chloride and infused at a rate of 0.25-0.5 grams per kilogram per hour (up to a maximal rate of 50 grams per hour), has been given. Multiple doses of activated charcoal have been given to infants six months of age or less.
  • Note: Some activated charcoal products contain sorbitol, which may cause severe diarrhea and vomiting. Many experts do not recommend the use of sorbitol in infants.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid if allergic or sensitive to activated charcoal products and their ingredients.

Side Effects and Warnings

  • Activated charcoal is likely safe when taken by mouth in recommended doses within one hour of ingesting a toxic substance. Common doses for adults are 50-100 grams and 10-25 grams for children.
  • Activated charcoal is possibly safe when applied to the skin as a dressing. It is possibly safe when used to treat bile flow problems during pregnancy, diarrhea caused by chemotherapy (in adults and children 1-18 years old), high cholesterol, and jaundice (yellowing in the skin) in newborns who are also receiving light therapy. Activated charcoal is possibly safe when used in people undergoing dialysis who have itchy skin. It is possibly safe when used to help eliminate drugs such as phenytoin and carbamazepine.
  • Use cautiously in people who have cancer and those taking anticancer agents. Activated charcoal may increase the risk of complications and mortality.
  • Use cautiously with propantheline, an antiulcer agent. Use cautiously with yogurt.
  • Use cautiously in people who have variegate porphyria, a blood disorder. Activated charcoal may worsen the condition and increase skin disease risk.
  • Use cautiously in people with high triglycerides. Activated charcoal may increase triglycerides.
  • Avoid if allergic or sensitive to activated charcoal products and their ingredients.
  • Avoid using with laxatives such as sorbitol. Taking activated charcoal and laxatives together may lead to electrolyte imbalances in adults. This combination may lead to severe diarrhea and vomiting in children.
  • Avoid using with ipecac, an agent that induces vomiting. Taking activated charcoal and ipecac together may lead to reduced effectiveness of activated charcoal.
  • Avoid using with whole bowel irrigation. Activated charcoal may reduce the effectiveness of whole bowel irrigation.
  • Avoid in people who have an unprotected airway, intestinal blockage, a perforation (hole) in the stomach or bowels, absence of bowel sounds, decreased muscle contraction and food movement in the digestive tract, or a risk of stomach bleeding, or those who have had recent surgery.
  • Avoid using for more than 3-4 days. Prolonged use of activated charcoal may cause nutrition and electrolyte problems.
  • Activated charcoal may also cause acute respiratory distress syndrome (lung problems that prevent oxygen intake), airway and lung inflammation, aspiration (breathing in a foreign object or substance), black stools, charcoal deposits in lymph nodes or tumors (in people with cancer), constipation, diarrhea, dizziness, drowsiness, a feeling of fullness in the stomach, headache, nausea, stomach blockage, and vomiting.

Pregnancy and Breastfeeding

  • In cases of acute poisoning, activated charcoal may be taken by pregnant or breastfeeding women. However, there is a lack of safety information on the potential effects of activated charcoal on pregnancy, breastfeeding, or the development of the fetus. A dose of 50 grams of activated charcoal taken by mouth three times daily for eight days has been safely used during pregnancy to reduce bile flow.

Interactions

Interactions with Drugs

  • Activated charcoal may interact with antibiotics, agents that block acetylcholine, cholesterol-lowering agents, ipecac, laxatives, and propantheline.
  • Note: Activated charcoal may interfere with the absorption of many drugs, herbs, foods, and vitamin supplements.

Interactions with Herbs and Dietary Supplements

  • Activated charcoal may interact with antibacterials, cholesterol-lowering herbs and supplements, and herbs and supplements that block acetylcholine.
  • Note: Activated charcoal may interfere with the absorption of many drugs, herbs, foods, and vitamin supplements.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Brahmi N, Kouraichi N, Thabet H, et al. Influence of activated charcoal on the pharmacokinetics and the clinical features of carbamazepine poisoning. Am J Emerg.Med 2006;24(4):440-443.
  2. Brok J, Buckley N, and Gluud C. Interventions for paracetamol (acetaminophen) overdose. Cochrane Database.Syst.Rev. 2006;(2):CD003328.
  3. Bucaretchi F and Baracat EC. [Acute toxic exposure in children: an overview]. J Pediatr (Rio J) 2005;81(5 Suppl):S212-S222.
  4. Chyka PA, Seger D, Krenzelok EP, et al. Position paper: Single-dose activated charcoal. Clin.Toxicol.(Phila) 2005;43(2):61-87.
  5. Coffin B, Bortolloti C, Bourgeois O, et al. Efficacy of a simethicone, activated charcoal and magnesium oxide combination (Carbosymag(R)) in functional dyspepsia: results of a general practice-based randomized trial. Clin.Res Hepatol.Gastroenterol. 2011;35(6-7):494-499.
  6. Craig S. Phenytoin poisoning. Neurocrit.Care 2005;3(2):161-170.
  7. Dargan PI, Colbridge MG, and Jones AL. The management of tricyclic antidepressant poisoning : the role of gut decontamination, extracorporeal procedures and fab antibody fragments. Toxicol.Rev. 2005;24(3):187-194.
  8. Greene SL, Kerins M, O'Connor N. Prehospital activated charcoal: the way forward. Emerg.Med J 2005;22(10):734-737.
  9. Hoegberg LC, Christophersen AB, Christensen HR, et al. Comparison of the adsorption capacities of an activated-charcoal--yogurt mixture versus activated-charcoal--water slurry in vivo and in vitro. Clin.Toxicol.(Phila) 2005;43(4):269-275.
  10. Kerihuel JC. Effect of activated charcoal dressings on healing outcomes of chronic wounds. J Wound Care 2010;19(5):208, 210-208, 215.
  11. Matteucci MJ, Habibe M, Robson K, et al. Effect of oral calcium disodium EDTA on iron absorption in a human model of iron overdose. Clin.Toxicol.(Phila) 2006;44(1):39-43.
  12. Roberts DM, Southcott E, Potter JM, et al. Pharmacokinetics of digoxin cross-reacting substances in patients with acute yellow Oleander (Thevetia peruviana) poisoning, including the effect of activated charcoal. Ther Drug Monit. 2006;28(6):784-792.
  13. Sergio GC, Felix GM, and Luis JV. Activated charcoal to prevent irinotecan-induced diarrhea in children. Pediatr Blood Cancer 2008;51(1):49-52.
  14. Spiller HA, Winter ML, Klein-Schwartz W, et al. Efficacy of activated charcoal administered more than four hours after acetaminophen overdose. J Emerg.Med 2006;30(1):1-5.
  15. Stass H, Kubitza D, Moller JG, et al. Influence of activated charcoal on the pharmacokinetics of moxifloxacin following intravenous and oral administration of a 400 mg single dose to healthy males. Br J Clin.Pharmacol. 2005;59(5):536-541.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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