1. Activated Charcoal (Medicinal GI Poison Decontamination Slurry)
2. Pharmacological Class: Universal Gastrointestinal Adsorbent Antidote • 3. Therapeutic Category: Vaccines, Immunologicals & Emergency Toxicology Antidotes (Ch 12)
4. Clinical Overview & Verified Formulation Identity
Activated Charcoal (Medicinal GI Poison Decontamination Slurry)
Code: [12.38] | Stable ID: TIP-MED-000270
Representative Indian Market Examples (Edition 2.7 Ch 12 [12.38], p. 173): Charcodote, Actidose, Ultra-Carbon — Strengths & Dosage Forms: Powder / Granules for Oral Suspension: 25 g, 50 g bottles/sachets.
Powder / Granules for Oral Suspension: 25 g, 50 g bottles/sachets.
Route: Oral / Parenteral / Topical as specified by formulation
Non-Schedule / OTC or Schedule K Permitted Preparation (Medical Supervision Recommended for High-Dose/Therapeutic Regimens)
True
5 & 6. Mechanism of Action & Pharmacodynamics
Pyrolysed carbon matrix with an immense internal pore network (surface area 950–2,000 m2 per gram) adsorbs non-polar organic drug and toxin molecules in the GI lumen via van der Waals forces -> prevents systemic absorption and interrupts enterohepatic/enteroenteric circulation.
8. Therapeutic Indications
- Acute gastrointestinal decontamination within 1 hour (or longer for modified-release/anticholinergic drugs) of potentially toxic oral ingestion of adsorbable drugs and poisons
- Multi-Dose Activated Charcoal (MDAC) for 'gut dialysis' of Carbamazepine, Phenobarbitone, Phenytoin, Theophylline, Dapsone, or Quinine
10. Dosage and Administration (Educational Reference Summary)
Administration & Timing: See Administration & Counselling below. | Standard clinical schedule per indication.
11 & 13. Contraindications, Precautions and Warnings
- Contraindications: UNPROTECTED AIRWAY (drowsy, stuporous, comatose, or seizing patient without a cuffed endotracheal tube—aspiration of charcoal causes fatal obliterative bronchiolitis and ARDS!); ingestion of caustics/corrosives (strong acids or alkalis—charcoal is ineffective and obscures urgent diagnostic endoscopy); ingestion of volatile hydrocarbons (kerosene, petrol, turpentine—high aspiration risk); bowel obstruction, ileus, or GI perforation. • Precautions: DOES NOT ADSORB ('PHAILS' Mnemonic): Pesticides (Organophosphates poorly if in hydrocarbon solvent—protect airway first!), Hydrocarbons, Acids/Alkalis/Alcohols (Ethanol, Methanol, Ethylene glycol), Iron salts, Lithium, or Solvents/Heavy Metals (Lead, Mercury, Arsenic, Potassium, Cyanide). Do not use sorbitol-containing charcoal repeatedly in MDAC (causes severe hypernatraemic dehydration in children).
Renal: No adjustment. • Hepatic: No adjustment.
7, 12, 14–18. Detailed Pharmacokinetics, Interactions, Special Populations & Counselling
7 & 16. Pharmacokinetics (ADME) & Renal / Hepatic Considerations
7. Pharmacokinetics (Absorption, Distribution, Metabolism, Excretion): Absorption, distribution, metabolism, and excretion follow class pharmacokinetic profile; verify patient renal/hepatic function.
16a. Renal Considerations: Renal: No adjustment. • Hepatic: No adjustment.
16b. Hepatic Considerations: Renal: No adjustment. • Hepatic: No adjustment.
12 & 14. Adverse Effects & Drug Interactions
- Black stools, vomiting, constipation, abdominal bloating.
- Pulmonary aspiration pneumonitis / ARDS (if given without airway protection), bowel obstruction or charcoal bezoar (if given in ileus).
- Adsorbs oral antidotes (e
- , oral Methionine or oral N-Acetylcysteine—use IV N-Acetylcysteine in Paracetamol overdose if Activated Charcoal was given) and stops absorption of all concurrent oral medications
15, 17 & 18. Special Populations, Clinical Monitoring & Patient Counselling
15. Use in Special Populations (Pregnancy, Lactation, Paediatrics, Geriatrics): Evaluate maternal-foetal benefit-risk ratio, paediatric mg/kg ceiling, and geriatric renal function prior to prescribing.
17. Clinical & Laboratory Monitoring: Monitor clinical response, baseline renal/hepatic parameters, and relevant serum biomarkers.
18. Patient Counselling & Storage:- Patient Counselling Checklist: Shake slurry thoroughly before drinking through a covered cup and straw (hiding the black appearance improves palatability in children); stools will turn black harmlessly for 2-3 days.
- Meal & Clock Timing Instruction: See Administration & Counselling below. (Standard clinical schedule per indication.)
- Missed Dose Protocol: Take as soon as remembered unless close to next scheduled dose; never double the dose.
- Geriatric Dispensing Pearl: Schedule: OTC / Non-Schedule | NLEM 2022: Yes | Compendia: IP 2026 / NFI 7th Ed 2026 / NLEM 2022 / BNF 90th Ed
Storage & Dispensing Notes: Store below 25°C–30°C in original moisture- and light-resistant packaging out of reach of children. Available forms: Powder / Granules for Oral Suspension: 25 g, 50 g bottles/sachets.
Visual Pharmacology Illustration (PLATE-8.1)
19. Authoritative References & Source Traceability
Primary Reference Record: Indian Pharmacist Desk Reference — Professional Edition 2.7 (2026–27) • Ch 12 [12.38] (p. 173)
Verification Portals: Indian Pharmacopoeia Commission (IPC) • CDSCO (India Jurisdiction) • NCBI Bookshelf • DailyMed (US FDA Label Reference)
Last Reviewed Date: 2026-11-08 • Related Study Guide: Clinical Pharmacokinetics: ADME, Vd, Clearance & Half-Life →