Activated charcoal (medication)

Activated charcoal, also known as activated carbon, is a medication used to treat poisonings that occurred by mouth.[1] To be effective it must be used within a short time of the poisoning occurring, typically an hour.[1][2] It does not work for poisonings by cyanide, corrosive agents, iron, lithium, alcohols, or malathion.[2] It may be taken by mouth or given by a nasogastric tube.[3] Other uses include inside hemoperfusion machines.[1]

For the pseudoscientific use, see Activated charcoal cleanse.
Main article: Activated carbon
Activated charcoal
Activated charcoal for medical use
Clinical data
Trade namesCharcoAid, others
AHFS/Drugs.comMonograph
Routes of
administration		by mouth, nasogastric tube
Identifiers
CAS Number
ChemSpider
  • none
UNII
CompTox Dashboard (EPA)
ECHA InfoCard100.036.697

Common side effects include vomiting, black stools, diarrhea, and constipation.[1] A more serious side effect, pneumonitis, may result if aspirated into the lungs.[1][2] Gastrointestinal obstruction and ileus are less common but serious adverse effects.[1] Use in pregnancy and breastfeeding is generally safe.[3] Activated charcoal works by adsorbing the toxin.[1]

While charcoal has been used since ancient times for poisonings, activated charcoal has been used since the 1900s.[4][5] It is on the World Health Organization's List of Essential Medicines.[6]

Medical uses

Poison ingestion

Activated charcoal is used to treat many types of oral poisonings such as phenobarbital and carbamazepine.[7] It is not effective for a number of poisonings including: strong acids or bases, iron, lithium, arsenic, methanol, ethanol or ethylene glycol.[7]

Although activated charcoal is the most commonly used agent for GI decontamination in poisoned patients, medical professionals use discretion when determining whether or not its use is indicated.[7] In a study of acute poisonings from agricultural pesticides and yellow oleander seeds, the administration of activated carbon did not affect survival rates.[8]

Charcoal biscuits were sold in England starting in the early 19th century, originally as remedy to flatulence and stomach trouble.[9]

Tablets or capsules of activated carbon are used in many countries as an over-the-counter drug to treat diarrhea, indigestion, and flatulence.[10] There is some evidence of its effectiveness to prevent diarrhea in cancer patients who have received irinotecan.[11] It can interfere with the absorption of some medications, and lead to unreliable readings in medical tests such as the guaiac card test.[12] 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.

Other

Claims that activated charcoal will do things such as whiten teeth, cure alcohol-induced hangovers, and prevent bloating, are not supported by evidence.[13][14] Activated charcoal cleanses also lack evidence and are considered pseudoscience.[15]

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.[16] The use of activated carbon is contraindicated when the ingested substance is an acid, an alkali, or a petroleum product.

Mechanism of action

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.

History

The use of charcoal as a medicinal product can be traced back to Egypt in 1500 BC, where it was used to neutralise bad odours from wounds. By 400 BC, the Phoenicians used charcoal to improve the taste of water stored on ships by containing the water in charred barrels, indicating that an understanding of charcoal's ability to adsorb undesirable chemicals was present by this time. Activated charcoal in its current form was developed during the 18th century, first being used during the sugar refining process to remove coloured impurities from raw sugar.[17] Medical use of activated charcoal commenced in the early 19th century; an often-cited experiment demonstrating its properties was carried out in 1835, where a dosage of strychnine mixed with activated charcoal resulted in no symptoms of poisoning being observed.[18]

References
  1. "Charcoal, Activated". The American Society of Health-System Pharmacists. Archived from the original on 21 December 2016. Retrieved 8 December 2016.
  2. World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 57. hdl:10665/44053. ISBN 9789241547659.
  3. Hamilton R (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 469. ISBN 9781284057560.
  4. Cecen F, Aktas Ö (2011-09-19). "1". Activated Carbon for Water and Wastewater Treatment: Integration of Adsorption and Biological Treatment. John Wiley & Sons. ISBN 9783527639458. Archived from the original on 2016-12-20.
  5. Tascón JM (2012). Novel Carbon Adsorbents. Elsevier. p. 640. ISBN 9780080977447. Archived from the original on 2016-12-20.
  6. World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  7. "Charcoal, Activated". The American Society of Health-System Pharmacists. Archived from the original on 22 May 2014. Retrieved 23 April 2014.
  8. Eddleston M, Juszczak E, Buckley NA, Senarathna L, Mohamed F, Dissanayake W, et al. (February 2008). "Multiple-dose activated charcoal in acute self-poisoning: a randomised controlled trial". Lancet. 371 (9612): 579–587. doi:10.1016/S0140-6736(08)60270-6. PMC 2430417. PMID 18280328.
  9. Rolland JL (2006). The Food Encyclopedia: Over 8,000 Ingredients, Tools, Techniques and People. Robert Rose. p. 148. ISBN 0-7788-0150-0.
  10. Stearn M (2007). Warts and all: straight talking advice on life's embarrassing problems. London: Murdoch Books. p. 333. ISBN 978-1-921259-84-5. Archived from the original on 2017-09-10. Retrieved 2009-05-03.
  11. Michael M, Brittain M, Nagai J, Feld R, Hedley D, Oza A, et al. (November 2004). "Phase II study of activated charcoal to prevent irinotecan-induced diarrhea". Journal of Clinical Oncology. 22 (21): 4410–4417. doi:10.1200/JCO.2004.11.125. PMID 15514383.
  12. Gogel HK, Tandberg D, Strickland RG (September 1989). "Substances that interfere with guaiac card tests: implications for gastric aspirate testing". The American Journal of Emergency Medicine. 7 (5): 474–480. doi:10.1016/0735-6757(89)90248-9. PMID 2787993.
  13. Brooks JK, Bashirelahi N, Reynolds MA (September 2017). "Charcoal and charcoal-based dentifrices: A literature review". Journal of the American Dental Association. 148 (9): 661–670. doi:10.1016/j.adaj.2017.05.001. PMID 28599961.
  14. "Can activated charcoal help with hangovers?". WebMD. Retrieved 13 March 2019.
  15. Medlin S (12 June 2018). "Activated charcoal doesn't detox the body – four reasons you should avoid it". The Conversation. Archived from the original on 13 June 2018. Retrieved 26 November 2019.
  16. Elliott CG, Colby TV, Kelly TM, Hicks HG (September 1989). "Charcoal lung. Bronchiolitis obliterans after aspiration of activated charcoal". Chest. 96 (3): 672–674. doi:10.1378/chest.96.3.672. PMID 2766830.
  17. "Charcoal is one of the most important substances ever discovered". Office for Science and Society. Retrieved 2023-08-02.
  18. Derlet RW, Albertson TE (October 1986). "Activated charcoal--past, present and future". The Western Journal of Medicine. 145 (4): 493–496. PMC 1306980. PMID 3538661.
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