Gastrointestinal decontamination / Antidote Pregnancy: Can be used if clearly indicated (not systemically absorbed).

Activated Charcoal

Brand names: CharcoAid, Actidose-Aqua

Adult dose

Dose: 50 g orally within 1 hour of ingestion

Route: Oral (nasogastric if unable to drink)

Frequency: Single dose (most situations); Multiple-dose (MDAC): 50 g every 4 hours for substances with enterohepatic recirculation

Max: 50 g per dose

Charcoal must be given within 1 hour of significant ingestion for best effect. Protect airway — give only to alert patients. MDAC (multiple-dose activated charcoal) for carbamazepine, dapsone, theophylline, quinine, phenobarbital. TOXBASE guidance essential.

Paediatric dose

Dose: 1 g/kg

Route: Oral

Frequency: Single dose

Max: 50 g

1 g/kg (max 50 g) orally. Can be mixed with juice or flavoured water to improve palatability. Children: charcoal slurry via NG tube if unable to drink.

Dose adjustments

Renal

Not applicable (not systemically absorbed).

Hepatic

Not applicable.

Paediatric weight-based calculator

Patient weight (kg)

1 g/kg (max 50 g) orally. Can be mixed with juice or flavoured water to improve palatability. Children: charcoal slurry via NG tube if unable to drink.

Clinical pearls

NOT effective for: iron, lithium, alcohols, acids/alkalis, hydrocarbons
Timing critical: most benefit within 1 hour, diminishing returns after
MDAC increases elimination of certain drugs — consult TOXBASE
Sorbitol-containing preparations: avoid routinely (abdominal cramps, hypotension in children)
Patient consent important — can be forcibly vomited and aspirated

Contraindications

Unprotected airway (altered consciousness/risk of aspiration)
Caustic/acid ingestion (corrosives — charcoal ineffective, worsens injury)
Hydrocarbon ingestion (high aspiration risk)
Intestinal obstruction

Side effects

Aspiration pneumonia (risk if airway not protected)
Nausea and vomiting
Constipation
Black stools

Interactions

Orally administered medications — activated charcoal adsorbs them (timing essential)

Monitoring

Airway patency
Oxygen saturation
Bowel sounds/motility

Reference: BNFc; BNF; TOXBASE; NPIS guidelines; Position Paper on Single-Dose Activated Charcoal (AACT/EAPCCT). Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways