1. Clinical & Scientific Overview
Activated Charcoal (Medicinal GI Poison Decontamination Slurry) (TIP-MED-000270, Reference Code [12.38]) is classified under
Vaccines, Immunologicals & Emergency Toxicology Antidotes (Ch 12) as a Universal Gastrointestinal Adsorbent Antidote.
Within the Indian regulatory and compendial framework, it is governed under Non-Schedule / OTC or Schedule K Permitted Preparation (Medical Supervision Recommended for High-Dose/Therapeutic Regimens).
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.
3. 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.
4. Therapeutic Indications & Evidence-Supported Uses
- 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
5. Educational Dosage Context, Formulations & Administration
Educational Dosing & Regimen Summary: Adult: Single-Dose GI Decontamination (within 1 hour of ingestion): 50–100 g (or 1 g/kg; 10:1 weight ratio of charcoal to ingested toxin) mixed in 250–400 mL water as an oral slurry or via nasogastric tube. Multi-Dose Activated Charcoal (MDAC for Carbamazepine/Theophylline/Phenobarbitone/Dapsone): 50 g initially, followed by 25 g q2h or 50 g q4h. • Paediatric: Children 1–12 years: 0.5–1 g/kg (typically 10–25 g in <5 yr; 25–50 g in 5–12 yr) mixed in water or fruit juice.
Administration & Meal Timing: See Administration & Counselling below. | Standard clinical schedule per indication.
6. Pharmacokinetics, Metabolism & Renal/Hepatic Adjustment
Absorption, distribution, metabolism, and excretion follow class pharmacokinetic profile; verify patient renal/hepatic function.
Renal: No adjustment. • Hepatic: No adjustment.
Renal: No adjustment. • Hepatic: No adjustment.
Renal: No adjustment. • Hepatic: No adjustment.
7. Contraindications, Precautions & High-Risk 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).
Key Clinical Precautions: Renal: No adjustment. • Hepatic: No adjustment.
8. Adverse Effects Profile
- Black stools, vomiting, constipation, abdominal bloating.
- Pulmonary aspiration pneumonitis / ARDS (if given without airway protection), bowel obstruction or charcoal bezoar (if given in ileus).
- Monitor for severe hypersensitivity, organ toxicity, or dose-limiting adverse events.
9. Major Drug–Drug, Drug–Food & Drug–Herb Interactions
- 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
10. Clinical Monitoring, Patient Counselling & Storage
Clinical & Laboratory Monitoring: Monitor clinical response, baseline renal/hepatic parameters, and relevant serum biomarkers.
Pharmacist 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, Stability & Dispensing Safeguards: 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.
11. Visual Pharmacology & Mechanism Diagram (svg-v339-01-adme-12-step-journey)
12. Authoritative References, Regulatory Sources & Editorial Disclaimer
Primary Compendial & Guideline Reference: Indian Pharmacist Desk Reference — Professional Edition 2.7 (2026–27) • Ch 12 [12.38] (p. 173)
Official Verification Portals: Indian Pharmacopoeia Commission (IPC) & National Formulary of India (NFI) • Central Drugs Standard Control Organization (CDSCO) • Ministry of Health & Family Welfare — NLEM 2022 • NCBI Bookshelf / StatPearls Pharmacology Reference • DailyMed (US FDA Official Prescribing Reference)
Last Medically & Pharmaceutically Reviewed: 2026-11-10 • Verification Status: HANDBOOK_SOURCE_CONTENT
Educational & Clinical Disclaimer: This reference profile is published solely for pharmacy education, academic study, and professional clinical reference. It does not substitute for patient-specific clinical judgement, qualified specialist oncology/medical supervision, or official CDSCO/IP prescribing information. Never self-medicate with prescription, Schedule H/H1/X, NDPS, or oncology medicines.