Activated Charcoal


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Oral Adsorbent (Systemic Drug)

Prescriber Highlights

  • Orally administered adsorbent for GI tract toxins and drug overdoses
  • Administration that is too rapid may induce emesis and aspiration
  • Monitor for hypernatremia in small dogs and cats
  • Activated charcoal can slow GI transit times, so it is often given with an osmotic cathartic to increase charcoal-toxin elimination 
  • Handle with care—charcoal stains clothes easily
Uses, Indications
  • Administered orally to adsorb certain drugs or toxins to prevent or reduce their systemic absorption
Contraindications, Precautions, Warnings
  • Contraindications

Should not be used for mineral acids, salt toxicosis (eg, Play-Doh, paintballs), hydrocarbons, or caustic alkalis, as it is either ineffective or dangerous

Other possible contraindications include GI obstruction or ileus, hypernatremia, hyperosmolar states, or imminent GI surgery or endoscopy

Although not contraindicated, it is ineffective for use with ethanol, methanol, ethylene glycol, xylitol, heavy metals, and ion salts

  • Precautions

Patients with altered mentation or decreased gag reflex and patients otherwise at risk for aspiration pneumonia should not receive activated charcoal

  • Warnings 

If the patient receives multiple doses of activated charcoal, giving a cathartic only once is recommended to prevent diarrhea, dehydration, and—potentially—hypernatremia 

Side Effects
  • Rapid administration can induce emesis, potentially resulting in aspiration pneumonia
  • Both constipation and diarrhea have been reported; feces will be black
  • Hypernatremia has been reported in small dogs and cats
Drug Interactions
  • Other orally administered therapeutic agents should be separated from the activated charcoal dose by at least 3 hours 
  • Polyethylene glycol electrolyte solutions, mineral oils, and dairy products may reduce the adsorptive capacity of activated charcoal
Monitoring
  • Dependent on the toxin or drug for which activated charcoal is being used—could include clinical signs and the serum levels of the drug or toxin 
  • Serum sodium levels, especially if the patient develops neurologic signs (eg, tremors, ataxia, seizures) associated with hypernatremia
Client Information
  • This agent should only be used with professional supervision to monitor for signs associated with hypernatremia
  • Charcoal can permanently stain fabrics
Dosage Forms
  • Both veterinary- and human-labeled products are available over the counter, including these formulations: 
    • Activated charcoal 10.4%, kaolin 6.25% suspension in 240-mL bottles; Toxiban® Suspension
    • Activated charcoal 10%, kaolin 6.25%, sorbitol 10% suspension in 240-mL bottles; Toxiban® Suspension with Sorbitol

Compiled and summarized from Plumb’s Veterinary Drugs by Shannon Palermo, VMD

Information about this drug was adapted from Plumb’s Veterinary Drugs. Further details and more therapeutics can be found with a subscription at plumbsveterinarydrugs.com

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