Activated charcoal

Activated charcoal/Drug Interactions:

  • GeneralGeneral: Activated charcoal interferes with the absorption of many drugs, herbs, foods, and vitamin supplements. Human studies have noted that the addition of sorbitol significantly decreases drug absorption (176; 177; 171; 178; 170). In other human research, activated charcoal has been reported to inhibit the enterohepatic circulation of some drugs or toxins and their metabolites (143; 179) and has been shown to adsorb some drugs or toxins back into the intestinal tract and bind with them (50; 180).
  • AntibioticsAntibiotics: In human research, an activated charcoal silver wound dressing reduced the number of bacteria and rates of wound infection (115). It is unclear if this effect was due to the combination of treatments or either agent alone.
  • AnticholinergicsAnticholinergics: In human research, the effectiveness of activated charcoal was enhanced in the presence of atropine (an anticholinergic drug) (181). In a simulated acetaminophen overdose, a single dose of activated charcoal alone reduced acetaminophen bioavailability by 20%, but with atropine, it was reduced by 47% (one hour after drug ingestion).
  • AntilipemicsAntilipemics: In humans, activated charcoal reduced serum total and LDL cholesterol and increased the ratio of HDL to LDL cholesterol, in a dose-dependent manner (122). An increase in triglyceride levels (approximately 37%) was noted during treatment with superactivated charcoal (131).
  • CatharticsCathartics: In human research, the addition of saline cathartics (magnesium sulfate [MgSO4] and sodium sulfate [Na2SO4]) to activated charcoal was found to reduce its gastrointestinal transit and residence times (130; 182).
  • IpecacIpecac: The American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists stated that ipecac may have reduced effectiveness if used concurrently with activated charcoal (132; 133; 134).
  • PropanthelinePropantheline: In human research, the addition of propantheline to activated charcoal was found to reduce its gastrointestinal transit and residence times (130).

    • Activated charcoal/Herb/Supplement Interactions:

  • GeneralGeneral: Activated charcoal interferes with the absorption of many drugs, herbs, foods, and vitamin supplements. Human studies have noted that the addition of sorbitol significantly decreases drug absorption (176; 177; 171; 178; 170). In other human research, activated charcoal has been reported to inhibit the enterohepatic circulation of some drugs or toxins and their metabolites (143; 179) and has been shown to adsorb some drugs or toxins back into the intestinal tract and bind with them (50; 180).
  • AntibacterialsAntibacterials: In human research, an activated charcoal silver wound dressing reduced the number of bacteria and rates of wound infection (115). It is unclear if this effect was due to the combination of treatments or either agent alone.
  • AnticholinergicsAnticholinergics: In human research, the effectiveness of activated charcoal was enhanced in the presence of atropine (an anticholinergic drug) (181). In a simulated acetaminophen overdose, a single dose of activated charcoal alone reduced acetaminophen bioavailability by 20%, but with atropine, it was reduced by 47% (one hour after drug ingestion).
  • AntilipemicsAntilipemics: In humans, activated charcoal reduced serum total and LDL cholesterol and increased the ratio of HDL to LDL cholesterol, in a dose-dependent manner (122). An increase in triglyceride levels (approximately 37%) was noted during treatment with superactivated charcoal (131).

    • Activated charcoal/Food Interactions:

  • GeneralGeneral: The presence of food in the stomach of drug overdose patients has been shown to modify the efficacy of activated charcoal and increase the time during which it may adsorb drugs in the gastrointestinal canal, possibly by slowing the gastric emptying rate (59). It has been suggested that coadministration of chocolate syrup or other dairy products, such as milk, ice cream, or sherbet, might decrease the adsorptive capacity of activated charcoal, although this has yet to be established in the literature.
  • Dairy productsDairy products: In human research, activated charcoal mixed with yogurt prolonged ingestion time compared to the charcoal-water mixture; however, palatability was not improved (21). In vitro, the yogurt mixture reduced adsorptive capacity by 9-13% compared to control.

    • Activated charcoal/Lab Interactions:

  • Bile acidsBile acids: In women with cholestasis of pregnancy, activated charcoal reduced serum total bile acids (119).
  • BilirubinBilirubin: Activated charcoal has been shown to significantly reduce bilirubin levels in hyperbilirubinemic neonates (126).
  • ElectrolytesElectrolytes: Experts suggest that prolonged use of activated charcoal (more than three days) may cause electrolyte depletion.
  • Lipid profileLipid profile: In humans, activated charcoal reduced serum total and LDL cholesterol and increased the ratio of HDL to LDL cholesterol, in a dose-dependent manner (122). An increase in triglyceride levels (approximately 37%) was noted during treatment with superactivated charcoal (131).

    • Activated charcoal/Procedures Interactions:

  • Whole-bowel irrigation (WBI)Whole-bowel irrigation (WBI): The American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists stated that whole-bowel irrigation may have reduced effectiveness if used concurrently with activated charcoal (135). However, a single dose of activated charcoal administered prior to whole-bowel irrigation did not appear to decrease the binding capacity of charcoal or to alter the osmotic properties of WBI solution (183).