Activated Charcoal (Toxiban®, Liqui-Char®, UAA Gel®)

Overview

Activated charcoal is a substance often used for the treatment of toxicity or suspected toxicity. It is used to absorb unwanted "drugs" or "toxins" that may have been ingested. 

Activated charcoal is a form of carbon that has been "activated" by exposing it to an oxidizing gas compound of steam, oxygen, and acids at high temperature. As a result of this exposure, the carbon matrix becomes permeated with a network of microscopic pores, effectively increasing its surface area. This physical change dramatically increases its capacity for adsorption. 

Adsorption is the adhesion of the molecules of gases, dissolved substances, or liquids in more or less concentrated form, to the surface of solids or liquids with which they are in contact. Clearly, the greater the surface area for adsorption, the greater will be the affinity of the substance for other materials. 

The maximum amount of a drug adsorbed by activated charcoal is approximately 100 to 1000 mg/g of the charcoal. 

The enormous potential for activated charcoal to attract other substances in this way, rendering then unavailable for transfer across the gut-blood barrier, is the reason for its clinical use as an emergency treatment for poisoning. 

Sorbitol is sometimes added to activated charcoal to a) increase its palatability to humans and b) increase the GI transit time and flush out charcoal-bound toxins more rapidly. 

Brand Names and Other Names

This compound is approved for use in humans and animals.

Human formulations: Actidose-Aqua (Paddock), Actidose with Sorbitol (Paddock), Liqui-Char (Jones Medical), CharcoAid (Requa), CharcoAid 2000 (Requa), and various generic preparations of activated charcoal.

Veterinary formulations: Toxiban® (Vet-A-Mix), Liqui-Char®-Vet (Jones Medical), UAA Gel® (Vedco), and generic activated charcoal suspensions or gels. 

Uses of Activated Charcoal

For emergency treatment of poisoning by most drugs and chemicals

Note: Activated charcoal is an ineffective treatment for poisoning involving mineral acids or alkalis. It is also not particularly effective for treatment of poisoning involving alcohols or iron salts.

Precautions and Side Effects

While generally safe and effective when prescribed by a veterinarian, activated charcoal can cause side effects in some animals. 

Activated charcoal should not be used in animals with known hypersensitivity orallergy to the drug.

Administration of high doses may cause vomiting

Constipation or diarrhea may occur

Stool will appear black

Sorbitol (when combined with activated charcoal) may cause vomiting, diarrhea, and dehydration

Aspiration of activated charcoal may cause respiratory obstruction and possibly fatal bronchiolitis. Therefore it should not be used in situations that may lead to aspiration such as pets with reduced consciousness or an inability to protect their airway

Drug Interactions

Activated charcoal will adsorb almost any drug given concomitantly and will thus decrease its physiological effects.

How Activated Charcoal is Supplied

As a powder, activated charcoal is supplied as 15, 30, 40, 120, and 240 gram aliquots

As granules, activated charcoal is supplied as 15 gm in 120 mL, or activated charcoal (47.5%) and kaolin (10%) granules in 1 lb bottles and 5 kg pails

The liquid form is supplied as 208 mg/mL in 60, 120, 240 mL bottles and also as 15 gm in 120 mL or 50 gm in 240mL

The suspension is available as 15 gm in 120 mL or 30 gm in 150mL. Activated charcoal (10.4%) and kaolin (6.25%) is supplied in 240 mL bottles

Dosing Information

Dogs and Cats:

Medication should never be administered without first consulting your veterinarian.

For poisonings, activated charcoal may be dosed orally at 1 to 4 gm/kg using granules or 6 to 12 ml/kg of the suspension

Activated charcoal can also be given as 1 g per 5 mL of water, thus 10 mL of the resulting slurry by mouth

In acute poisoning, activated charcoal is can be given as high a dose as 8 g/kg orally every 8 hours

For slowly eliminated poisons, a dose of 0.5 mg/kg every 3 hours for 72 hours may be used

The duration of administration depends on the condition being treated, response to the medication and the development of any adverse effects. 

Multiple administrations may be helpful in severe poisoning to prevent desorption from the charcoal and to facilitate clearance of drugs that undergo enterohepatic recirculation.