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Gastrointestinal decontamination / Antidote Pregnancy: The safety of this medicinal product for use in human pregnancy has not been established. Experimental animal studies are insufficient to assess the safety with respect to the development of the embryo or foetus, the course of gestation and peri and postnatal development. Activated charcoal is however essentially inert pharmacologically and is not absorbed from the gastrointestinal tract. No hazard is therefore anticipated from its use during pregnancy or lactation. (UK SPC §4.6)

Activated Charcoal

Brand names: CharcoAid, Actidose-Aqua

Used in: Poisoning & Overdose

Activated charcoal is an oral adsorbent that binds many ingested poisons within the gut to reduce their absorption, and is most effective when given soon after ingestion.

Adult dose

Dose: Emergency treatment of acute oral poisoning or drug overdose, when the amount of poison ingested is unknown: adults (including the elderly) and children over 12 years 50 g activated charcoal (one standard treatment pack), repeated if necessary, taken as soon as possible after ingestion of the poison. If the dose of poison ingested is known, a ratio of 10:1 (activated charcoal: toxin) may be used to determine the optimal dose of activated charcoal, subject to the limits of practicality. Multiple dose therapy: 25-50 grams of activated charcoal every 4-6 hours. Product: Carbomix 50 g granules for oral suspension (charcoal activated 81.3% w/w)
Route: Oral (granules mixed with water and swallowed as a suspension under medical supervision), or by intragastric tube using the applicator provided
Frequency: Single dose as soon as possible after ingestion, repeated if necessary; multiple dose therapy every 4-6 hours
Product: UK SPC via MHRA Products - CARBOMIX 50G GRANULES FOR ORAL SUSPENSION (PL514630098), Kent Pharma UK Limited; §2: charcoal activated 81.3% w/w. §4.1 (verbatim): 'Emergency treatment of acute oral poisoning or drug overdose.' COVERAGE: this SPC covers Carbomix only; other activated charcoal products (including the other brand listed on this page) have their own labelling and are not covered. §4.2 does not give a numeric dose for the multiple-dose regimen beyond '25-50 grams ... every 4-6 hours' and prints no maximum dose or total duration, so none is given. METHOD (§4.2): 'Carbomix granules should be mixed with water and swallowed as a suspension under medical supervision. The contents of the bottle are made up to the red band with water and shaken thoroughly prior to administration.' It should be given as soon as possible after ingestion; it 'may be effective even when several hours have elapsed after ingestion of the poison if gastrointestinal motility is reduced by the toxin or if the drug is subject to enterohepatic or enteroenteric recycling'. 'Induction of emesis is not recommended because there is no evidence that it affects absorption and it may increase the risk of aspiration.' If gastric lavage is used, 'a single dose of Carbomix may be administered early in the procedure' (lavage returns will be black). When ipecac syrup is used to induce emesis, Carbomix should be given only after vomiting has been induced and completed, since ipecac syrup is adsorbed by the charcoal. SPC §4.1 on repeat dosing: 'In severe intoxication, repeated administration of Carbomix is recommended to prevent absorbed drug being released (in an unbound state) in the lower intestinal tract or to expedite the elimination and prevent the re-absorption of any drug undergoing enterohepatic circulation.' CONTRAINDICATED in persons who are not fully conscious (§4.3). LITTLE OR NO VALUE (§4.4) in poisoning with cyanides, alcohols, iron salts, malathion and DDT; not recommended after ingestion of corrosive agents such as strong acids or alkalis (it may obscure endoscopic visualisation). It is an adjunct: proper basic life support measures must be implemented first where required. PAEDIATRIC UNDER 1 YEAR: the SPC prints a single-dose figure for 'Children under 1 year of age' but its age band does not exclude neonates and the figure is expressed as '1g or 5ml per kg' with no stated relationship, so it is NOT carried onto this page; use a children's formulary and local toxicology advice. The old openFDA record in this bundle (a homeopathic combination product) was not used.

Paediatric dose

Dose: Acute oral poisoning or drug overdose, children aged 1-12 years: 25g -50g activated charcoal (half the contents of the standard pack, repeated if necessary), taken as soon as possible after ingestion of the poison. For multiple dose therapy, the dose may be repeated every 4-6 hours. (Carbomix 50 g granules for oral suspension; charcoal activated 81.3% w/w)
Route: Oral (granules mixed with water and swallowed as a suspension under medical supervision), or by intragastric tube using the applicator provided
Frequency: Single dose as soon as possible after ingestion, repeated if necessary; multiple dose therapy may be repeated every 4-6 hours
THESE ARE THE LABEL'S OWN FIGURES for 'Children aged 1-12 years' (SPC §4.2), not scaled adult doses. The SPC's separate 'Children under 1 year of age' regimen is deliberately not written here (its age band includes neonates and its '1g or 5ml per kg' wording is ambiguous) - use a children's formulary and local toxicology advice for infants. Children over 12 years take the adult dose.

Dose adjustments

Renal

No renal dose adjustment is stated in the SPC (§4.2).

Hepatic

No hepatic dose adjustment is stated in the SPC (§4.2).

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via MHRA Products — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Persons who are not fully conscious (§4.3 - the only contraindication listed)
  • Not recommended (§4.4, a warning rather than a contraindication): patients who have ingested corrosive agents such as strong acids or alkalis, since the activated charcoal may obscure endoscopic visualisation of oesophageal and gastric lesions produced by the toxin

Side effects

  • Black stools (frequency not known) (§4.8)
  • Airways obstruction - aspiration of activated charcoal has been reported to produce airways obstruction (frequency not known) (§4.4, §4.8)
  • Gastrointestinal obstruction, associated with the use of multiple dose activated charcoal therapy (frequency not known) (§4.8)
  • Gastrointestinal disturbances including vomiting, constipation and diarrhoea (frequency not known) (§4.8)

Interactions

  • Carbomix will adsorb most medicaments and many other chemical substances; if a specific antidote is to be administered, the likelihood of its adsorption by activated charcoal should be borne in mind and a parenteral route of administration used if possible (§4.5)
  • Paracetamol: Carbomix should not be given as well as oral methionine but may be used alone or in conjunction with intravenous N-acetylcysteine (§4.5)
  • Other concurrent medications to counteract shock or associated infection should be given parenterally, since orally administered drugs may be bound to the activated charcoal in the gut (§4.5)
  • Ipecac syrup: give Carbomix only after vomiting has been induced and completed, since ipecac syrup is adsorbed by the charcoal, preventing emesis (§4.2)

Monitoring

  • Bowel sounds should be monitored frequently to assess peristaltic action, especially in patients undergoing multiple dose activated charcoal therapy (§4.4)
  • Use with caution in patients exposed to toxins which interfere with gastrointestinal motility (e.g. anticholinergics, opioids) (§4.4)
  • Aspiration of activated charcoal has been reported to produce airways obstruction; appropriate precautions should be taken (§4.4)
  • A laxative may be given concurrently to accelerate removal of the charcoal-toxin complex, but with caution and only intermittently during multiple dose therapy, since profuse and protracted diarrhoea may lead to fluid and electrolyte imbalance (§4.4)
  • Patients and health care professionals should be aware that Carbomix will produce black stools (§4.4)

Clinical monograph

How it works

Its very large adsorptive surface area binds many drugs and toxins in the gastrointestinal lumen, reducing systemic absorption; repeated doses can also enhance elimination of some drugs by interrupting enterohepatic and enteroenteric recycling.

Prescribing in practice

  • It requires a protected airway because of the aspiration risk — avoid in a drowsy or obtunded patient unless the airway is secured by intubation.
  • It does not bind metals (such as iron or lithium), alcohols, corrosives or many solvents, so it is ineffective for these poisonings.
  • Repeated doses are used for certain poisons; confirm indications and timing with Toxbase/NPIS.

Monitoring

Assess and monitor conscious level and airway protection before and after administration, watch for vomiting and signs of aspiration, and review bowel sounds, especially with repeated doses.

Counselling the patient

  • Warn the team that charcoal is only useful early and that a safe, protected airway is a prerequisite.
  • Note that it is ineffective against metals, alcohols and corrosives.
  • Check Toxbase/NPIS for whether single or repeated doses are appropriate for the specific poison.

Evidence & guidelines

Standard gut decontamination option in selected poisonings (Toxbase/NPIS).

Reference: TOXBASE; NPIS guidelines; Position Paper on Single-Dose Activated Charcoal (AACT/EAPCCT); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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