Activated Charcoal (Medicinal GI Poison Decontamination Slurry)
Universal Gastrointestinal Adsorbent Antidote • Non-Schedule / OTC or Schedule K Permitted Preparation (Medical Supervision Recommended for High-Dose/Therapeutic Regimens)
Level 1 — Quick Professional Summary (At a Glance)
Activated Charcoal (Medicinal GI Poison Decontamination Slurry)
Monograph 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.
Universal Gastrointestinal Adsorbent Antidote
Vaccines, Immunologicals & Emergency Toxicology Antidotes (Ch 12)
Powder / Granules for Oral Suspension: 25 g, 50 g bottles/sachets.
Route: Oral / Parenteral / Topical as specified by formulation
9–10. 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.
12. 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
13 & 16. Contraindications, Precautions & 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.
14. Dosage & Administration Context (Educational Reference Summary)
Administration & Timing: See Administration & Counselling below. | Standard clinical schedule per indication.
Level 2 — Detailed Pharmacology, PK, Interactions & Special Populations
11 & 19. Pharmacokinetics (ADME), Renal & Hepatic Considerations
Pharmacokinetic Profile: Absorption, distribution, metabolism, and excretion follow class pharmacokinetic profile; verify patient renal/hepatic function.
Renal Considerations: Renal: No adjustment. • Hepatic: No adjustment.
Hepatic Considerations: Renal: No adjustment. • Hepatic: No adjustment.
15 & 17. Adverse Effects & Clinically Significant 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
18, 20, 21 & 22. Special Populations, Monitoring, Counselling & Storage
Pregnancy, Lactation, Paediatric & Geriatric Use: Evaluate maternal-foetal benefit-risk ratio and age-appropriate organ function before prescribing.
Clinical & Laboratory Monitoring: Monitor clinical response, baseline renal/hepatic parameters, and relevant serum biomarkers.
Patient Counselling Points:- 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 Governance: 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 Mechanism Diagram (PLATE-8.1)
23. Traceable Source References & Jurisdiction
Primary Reference Record: Indian Pharmacist Desk Reference — Professional Edition 2.7 (2026–27) • Ch 12 [12.38] (p. 173)
Authoritative Verification Portals: Indian Pharmacopoeia Commission (IPC) • CDSCO (India Jurisdiction) • NCBI Bookshelf • DailyMed (US FDA Label Reference)
Last Checked Date: 2026-11-08 • Related Study Guide: Clinical Pharmacokinetics: ADME, Vd, Clearance & Half-Life →