Carbon

Related Terms

AC, Acta-Char?, Actidose?, Actidose AquaT, activated carbon, activated carbon nanoparticles adsorbing mitomycin C (MMC-ACNP), activated coal, Adsorba?, animal charcoal, Arm-a-char?, AST-120, carbo (Latin), Carbomix?, Carbomix? BP, carbon, Carbosorb? X, carv?o vegetal (Portuguese), charbon de bois (French), CharcoAid?, charcoal, Charcocaps?, Charcodote?, CharcotraceT, chitosan encapsulated activated charcoal beads (ACCB), CHR-30, dreven? uhl? (Czech), EZ-CharT, gas black, gastrointestinal decontamination agent, Holzkohle (German), Insta-Char?, Kremezin?, lamp black, Liqui-Char?, Medicoal?, Merckmezin?, mitomycin C bound to activated carbon particles (MMC-AC or MMC-CH), multiple-dose activated charcoal (MDAC), Norit? A Supra, Norit? C, Norit? C Extra, Nuchar?, oral activated charcoal (OAC), SIAX, silver-impregnated activated charcoal, single-dose activated charcoal (SDAC), Super-Char?, superactivated charcoal, tr?kul (Danish), trekull (Norwegian), vi?arkol (Icelandic).
Select combination products: Carbosylane? (simethicone and activated charcoal); Carbosymag? (simethicone, activated charcoal, and magnesium oxide); Carbosorb? XS (50g of activated charcoal and 100g of sorbitol in 250mL); Actisorb? Silver 220 (silver-impregnated activated charcoal dressing).

Background

Activated charcoal is a carbon-rich material that has been processed to have an increased surface area. Activated charcoal is widely used for treating drug overdoses and poisonings.
Activated charcoal is most effective if used within one hour of ingesting toxic substances. It has proven to be effective in both adult and child overdoses of drugs such as acetaminophen, digoxin, digitoxin, tricyclic antidepressants, and barbiturates. However, activated charcoal is not effective in poisonings caused by strong acids or bases, cyanide, organic solvents, ethanol, methanol, iron, or lithium, among other substances.
Activated charcoal has been traditionally given with laxatives to encourage removal of toxic contents and improve tolerance to charcoal. However, in 2004 and 1997, the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists stated that they do not endorse the combination of activated charcoal with a laxative. This combination may cause serious side effects such as dehydration, electrolyte imbalances, and low blood pressure.
Activated charcoal has been studied for many stomach disorders, including diarrhea, gas, and indigestion. Research suggests that activated charcoal may benefit people who have diarrhea caused by chemotherapy. When combined with simethicone, activated charcoal may improve symptoms of indigestion. Activated charcoal may also improve bloating and stomach cramps and prevent gas.
Due to its adsorbing effects (attracts substances to the surface of the material), activated charcoal may help treat liver and kidney disorders. Taking activated charcoal by mouth may lower cholesterol levels and reduce high levels of bile acids. Charcoal may also be given with light therapy to help prevent jaundice (yellowing of the skin) in newborn babies.
Activated charcoal particles have been studied as a drug delivery system to improve effectiveness of therapies and reduce chemotherapy agent side effects. However, more research is needed in this area.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Activated charcoal has strong adsorbent properties. It is most effective when given within one hour after ingestion of toxic substances. Activated charcoal has been traditionally given with laxatives such as sorbitol or magnesium citrate. However, the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists have stated that they do not endorse this combination.

 A


Activated charcoal has strong adsorbent properties. It is most effective when given within one hour after ingestion of toxic substances. Activated charcoal has been traditionally given with laxatives such as sorbitol or magnesium citrate. However, the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists have stated that they do not endorse this combination.

 A


Research suggests that activated charcoal may benefit people who have diarrhea. However, it is not considered standard care for nonspecific diarrhea. Studies report that activated charcoal may be effective in preventing diarrhea in people undergoing chemotherapy. Experts warn against using activated charcoal with other agents used to treat diarrhea.

 B


Research suggests that activated charcoal may benefit people who have diarrhea. However, it is not considered standard care for nonspecific diarrhea. Studies report that activated charcoal may be effective in preventing diarrhea in people undergoing chemotherapy. Experts warn against using activated charcoal with other agents used to treat diarrhea.

 B


Itchy skin may be caused by advanced chronic kidney failure and dialysis. Research suggests that activated charcoal may benefit people with this condition. The reasons for this benefit are not well understood. However, experts suggest that activated charcoal may adsorb a compound that causes the itching.

 B


Itchy skin may be caused by advanced chronic kidney failure and dialysis. Research suggests that activated charcoal may benefit people with this condition. The reasons for this benefit are not well understood. However, experts suggest that activated charcoal may adsorb a compound that causes the itching.

 B


Studies suggest that high levels of bile acids may lead to bile flow problems in pregnancy. Early evidence shows that activated charcoal may be effective in preventing this condition. However, more research is needed in this area.

 C


Studies suggest that high levels of bile acids may lead to bile flow problems in pregnancy. Early evidence shows that activated charcoal may be effective in preventing this condition. However, more research is needed in this area.

 C


Anticancer drugs have been found to be unsuccessful in reducing secondary cancer development in people who have had stomach cancer surgery. Early research suggests that chemotherapy with mitomycin C adsorbed onto activated charcoal (MMC-CH) may help increase survival rates after stomach cancer surgery. However, more research is needed in this area.

 C


Anticancer drugs have been found to be unsuccessful in reducing secondary cancer development in people who have had stomach cancer surgery. Early research suggests that chemotherapy with mitomycin C adsorbed onto activated charcoal (MMC-CH) may help increase survival rates after stomach cancer surgery. However, more research is needed in this area.

 C


Some studies suggest that activated charcoal may adsorb gas. However, results are inconsistent. More research is needed in this area.

 C


Some studies suggest that activated charcoal may adsorb gas. However, results are inconsistent. More research is needed in this area.

 C


Early research reports that activated charcoal may lower cholesterol levels. More research is needed in this area.

 C


Early research reports that activated charcoal may lower cholesterol levels. More research is needed in this area.

 C


Early research suggests that activated charcoal plus simethicone (with or without magnesium oxide) may reduce indigestion symptoms. More research is needed on the potential effects of activated charcoal alone.

 C


Early research suggests that activated charcoal plus simethicone (with or without magnesium oxide) may reduce indigestion symptoms. More research is needed on the potential effects of activated charcoal alone.

 C


Research shows that activated charcoal may help reduce nitrogen-containing waste products. A low-protein diet combined with activated charcoal has been found to benefit elderly people who have advanced kidney disease. Other research found that Kremezin?, an activated charcoal formula sold in Japan, may have more benefit for kidney function than Merckmezin?, another product available in Japan. More research is needed in this area.

 C


Research shows that activated charcoal may help reduce nitrogen-containing waste products. A low-protein diet combined with activated charcoal has been found to benefit elderly people who have advanced kidney disease. Other research found that Kremezin?, an activated charcoal formula sold in Japan, may have more benefit for kidney function than Merckmezin?, another product available in Japan. More research is needed in this area.

 C


High levels of bilirubin, a compound found in the bile, may lead to jaundice (yellowing of the skin) in newborn babies. Light therapy is the most common treatment for this condition. Early evidence suggests that activated charcoal may help increase the effects of light therapy. Additional research is needed in this area.

 C


High levels of bilirubin, a compound found in the bile, may lead to jaundice (yellowing of the skin) in newborn babies. Light therapy is the most common treatment for this condition. Early evidence suggests that activated charcoal may help increase the effects of light therapy. Additional research is needed in this area.

 C


Evidence suggests that activated charcoal dressings that contain silver may help decrease bacteria and speed healing time. This therapy may have greater benefit than some ointments or zinc paste. Additional research is needed in this area.

 C


Evidence suggests that activated charcoal dressings that contain silver may help decrease bacteria and speed healing time. This therapy may have greater benefit than some ointments or zinc paste. Additional research is needed in this area.

 C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Dosing

Adults (18 years and older)
Note: A single dose of activated charcoal with a cathartic (e.g., sorbitol, magnesium citrate) within one hour of oral toxin ingestion has been traditionally used. However, in 2004 and 1997, position statements from the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists stated that the combination of activated charcoal with a cathartic is not endorsed. This group of experts also cautioned against the use of ipecac with activated charcoal, as this may reduce its effectiveness.
Multiple-dose activated charcoal may be called for in certain circumstances, but only if a patient has ingested a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine, or theophylline.
A limitation of the use of activated charcoal is its taste and texture. It has been described as a gritty and unpleasant black liquid and may cause vomiting. Yogurt has been used to improve the taste and texture of activated charcoal; however, some research has shown that mixing activated charcoal with yogurt instead of water prolonged ingestion time but did not improve the palatability in adults. In other research, a formulation of activated charcoal, CharcoAid?, was found to be more palatable than an older nongranulated formulation and may improve patient compliance.
To treat bile flow problems in pregnancy, 50 grams of activated charcoal has been taken by mouth three times daily for eight days.
To prevent or treat diarrhea caused by chemotherapy, 1,000 milligrams of activated charcoal (Charcodote?, Pharmascience, Montreal, Canada) has been taken by mouth before chemotherapy and three times daily for 48 hours after chemotherapy (at three different dose levels: dose level 1 being 30 milliliters of diluted solution (1,000 milligrams of Charcodote? in 25 milliliters of water); dose level 2 being 60 milliliters of diluted solution(2,000 milligrams of Charcodote? in 50 milliliters of water); and dose level 3 being 90 milliliters of diluted solution (3,000 milligrams of Charcodote? in 75 milliliters of water).
To reduce gas, 260 milligrams of activated charcoal has been taken by mouth after ingestion of lactulose (performed twice). Three capsules of 194 milligrams of activated charcoal have been taken by mouth immediately after a gas-producing meal, followed by the same dose given two hours after the first. Three capsules of activated charcoal have been taken by mouth immediately after a gas-producing meal, followed by three additional capsules at 30-minute intervals until a total of 15 capsules were taken.
To treat high cholesterol, 15-30 grams of activated charcoal have been taken by mouth in divided doses for up to 12 weeks. A dose of 20 grams of superactivated charcoal has been taken by mouth twice daily.
To treat poisoning, an adult dose of activated charcoal of 50-100 grams has been taken by mouth as a single dose or multiple doses. Activated charcoal has been taken by mouth in a ratio of at least 10:1 (charcoal:toxin) by weight. Lower doses of 10-25 grams have been taken by mouth. In acute drug poisoning, the following doses have been taken by mouth: an initial dose of 50-100 grams, followed by one of the following schedules: 12.5 grams every hour, 25 grams every two hours, or 50 grams every four hours. Multiple doses of activated charcoal have been taken by mouth to enhance effects. The American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists state that multiple doses should only be used in cases of ingestion of a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine, or theophylline.
Note: Vomiting is considered a common problem after taking activated charcoal by mouth for ingested poisons. Agents that treat nausea and vomiting may be given.
Charcoal hemoperfusion (a technique in which blood passes through a column with activated charcoal to remove toxic substances) has been used.
To treat itchy skin in people with kidney disorders, six grams of activated charcoal has been taken by mouth daily for up to eight weeks.
To promote wound healing, activated charcoal dressings that contain silver have been applied to the skin. The product Actisorb? Silver 220 has been applied to the skin and may also be covered with a bandage and left for up to seven days.
As an additional therapy for cancer, 50 milligrams of mitomycin adsorbed onto activated charcoal has been delivered into the stomach cavity.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Interactions

Interactions with Drugs
Activated charcoal may interact with antibiotics, agents that block acetylcholine, cholesterol-lowering agents, ipecac, laxatives, and propantheline.
Note: Activated charcoal may interfere with the absorption of many drugs, herbs, foods, and vitamin supplements.

Attribution

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Brahmi N, Kouraichi N, Thabet H, et al. Influence of activated charcoal on the pharmacokinetics and the clinical features of carbamazepine poisoning. Am J Emerg.Med 2006;24(4):440-443.
Brok J, Buckley N, and Gluud C. Interventions for paracetamol (acetaminophen) overdose. Cochrane Database.Syst.Rev. 2006;(2):CD003328.
Bucaretchi F and Baracat EC. [Acute toxic exposure in children: an overview]. J Pediatr (Rio J) 2005;81(5 Suppl):S212-S222.
Chyka PA, Seger D, Krenzelok EP, et al. Position paper: Single-dose activated charcoal. Clin.Toxicol.(Phila) 2005;43(2):61-87.
Coffin B, Bortolloti C, Bourgeois O, et al. Efficacy of a simethicone, activated charcoal and magnesium oxide combination (Carbosymag(R)) in functional dyspepsia: results of a general practice-based randomized trial. Clin.Res Hepatol.Gastroenterol. 2011;35(6-7):494-499.
Craig S. Phenytoin poisoning. Neurocrit.Care 2005;3(2):161-170.
Dargan PI, Colbridge MG, and Jones AL. The management of tricyclic antidepressant poisoning : the role of gut decontamination, extracorporeal procedures and fab antibody fragments. Toxicol.Rev. 2005;24(3):187-194.
Greene SL, Kerins M, O'Connor N. Prehospital activated charcoal: the way forward. Emerg.Med J 2005;22(10):734-737.
Hoegberg LC, Christophersen AB, Christensen HR, et al. Comparison of the adsorption capacities of an activated-charcoal--yogurt mixture versus activated-charcoal--water slurry in vivo and in vitro. Clin.Toxicol.(Phila) 2005;43(4):269-275.
Kerihuel JC. Effect of activated charcoal dressings on healing outcomes of chronic wounds. J Wound Care 2010;19(5):208, 210-208, 215.
Matteucci MJ, Habibe M, Robson K, et al. Effect of oral calcium disodium EDTA on iron absorption in a human model of iron overdose. Clin.Toxicol.(Phila) 2006;44(1):39-43.
Roberts DM, Southcott E, Potter JM, et al. Pharmacokinetics of digoxin cross-reacting substances in patients with acute yellow Oleander (Thevetia peruviana) poisoning, including the effect of activated charcoal. Ther Drug Monit. 2006;28(6):784-792.
Sergio GC, Felix GM, and Luis JV. Activated charcoal to prevent irinotecan-induced diarrhea in children. Pediatr Blood Cancer 2008;51(1):49-52.
Spiller HA, Winter ML, Klein-Schwartz W, et al. Efficacy of activated charcoal administered more than four hours after acetaminophen overdose. J Emerg.Med 2006;30(1):1-5.
Stass H, Kubitza D, Moller JG, et al. Influence of activated charcoal on the pharmacokinetics of moxifloxacin following intravenous and oral administration of a 400 mg single dose to healthy males. Br J Clin.Pharmacol. 2005;59(5):536-541.