Activated charcoal is the residue obtained from destructive distillation of various organic materials (generally wood pulp or vegetables, but also sucrose, lactose, bone, blood, and industrial wastes), which is subsequently treated to increase its adsorptive capacity. Steam, air, CO2, O2, zinc chloride, sulfuric acid, or phosphoric acid at temperatures of 500-900 degrees F "activate" the residue. This process removes previously adsorbed substances and can break down granules to even smaller ones, thereby increasing their effective surface area. Activated charcoal was approved by the FDA in 1940, but its adsorbent properties were first described in 1791. In 1830, Touery, a French pharmacist, conclusively demonstrated the protective ability of charcoal by ingesting several times the lethal dose of strychnine together with 15 g of charcoal with no ill effects. However, as recently as 1975, charcoal was not recognized as a drug, and commercial formulations specified that it not be used in humans. In 1979, Neuvonen described the use of charcoal to prevent absorption of various drugs, and in 1982, the ability of charcoal to accelerate systemic clearance of phenobarbital and theophylline was reported. The adsorptive properties of activated charcoal make it an effective general purpose antidote.
Three gastric decontamination procedures have been widely used for the treatement of toxic ingestions: gastric lavage, ipecac, and activated charcoal. Their role has recently been reviewed and position statements developed by working groups of the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. These statements indicate that single-dose activated charcoal is now the agent of choice for gastric decontamination when decontamination is indicated. Single-dose activated charcoal is not recommended for routine use in the management of poisoned patients. The administration of activated charcoal may be considered if a patient has ingested a potentially toxic amount of a poison (which is known to be adsorbed to charcoal) up to 1 hour previously; there are insufficient data to support or exclude its use after 1 hour of ingestion. There is no evidence that the administration of activated charcoal improves clinical outcome. Although studies and case reports demonstrate that multiple-dose activated charcoal increases drug elimination significantly, a 1999 position statement stated that multiple-doses of charcoal have not yet been shown to reduce morbidity and mortality in poisoned patients. Further studies are required to establish its role and the optimal dosage regimen of charcoal to be administered. Based on experimental and clinical studies, multiple-doses of activated charcoal should be considered only if a patient has ingested a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine, or theophylline.
Activated charcoal may adsorb irritants that can cause diarrhea, but the value of the drug in treating diarrhea has not been established. Charcoal is also claimed to adsorb intestinal gases in the management of flatulence, dyspepsia, and intestinal distension, but the effectiveness of the drug for these conditions is not known and is not FDA approved. Charcoal is not an effective treatment for infectious diarrhea or for food poisoning, nor is it an effective preventative agent for traveler's diarrhea. Activated charcoal capsules and tablets are marketed as dietary supplements, and are not FDA approved non-prescription (OTC) drugs.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
Route-Specific Administration
Oral Administration
-Administer orally to patients with an intact gag-reflex and/or a protected airway.
-Do NOT use milk, chocolate syrup, ice cream, or sherbet as a vehicle for the administration of activated charcoal because the adsorptive capacity is substantially decreased.
-Do not administer other drugs 2 hours before or after administration of charcoal.
Oral Solid Formulations
-Do not use activated charcoal tablets or capsules to treat overdosages.
Extemporaneous Compounding-Oral
Activated charcoal powder for oral suspension:
-To prepare an extemporaneous preparation, mix dose in at least 6-8 ounces of water and administer as a slurry. Juice, cocoa, or chocolate powder may be added to make more palatable. May be further diluted for administration via gastric tube.
Activated charcoal powder for oral solution:
-To prepare an extemporaneus preparation, mix dose in at least 8 ounces of liquid and administer orally.
-In an emergency, the 1 ounce charcoal activated powder bottle may be filled with water, and the contents administered orally.
The principal adverse reactions associated with activated charcoal administration are gastrointestinal in nature and include vomiting, constipation, diarrhea, and tongue discoloration and stool discoloration. Abdominal pain or distention may also occur but are less frequent. Such side effects are more likely to occur with multiple-dose, chronic administration; adverse events are usually negligable when charcoal is administered acutely for GI decontamination in overdose. Patients who ingest activated charcoal in non-overdose situations for flatulence or other purposes should be aware that the effectiveness of other regularly taken medications (e.g., digoxin, oral contraceptives) may be decreased.
Charcoal capsules and tablets are not effective in treating poisonings.
Activated charcoal oral suspension should be used in children only under the direct supervision of a health care prescriber or poison control center. The product label for activated charcoal oral solution contains dosing information for pediatric patients ages 0-12 years. Keep all activated charcoal containing products out of the reach of children.
Activated charcoal oral suspension and solution should not be used in patients with gag reflex depression (e.g., decreased consciousness or active seizures) or who may be at risk for drug/toxin-induced coma, unless the airway is protected. The effectiveness of activated charcoal is greatest within 1 hour of ingestion. Administration may be considered if a patient has ingested a potentially toxic amount of a poison (which is known to be adsorbed to charcoal) up to 1 hour previously; there are insufficient data to support or exclude its use after 1 hour of ingestion. There is no evidence, based on guidance statements, that the administration of activated charcoal, even in single doses, improves clinical outcome. It should be noted that activated charcoal is not effective in adsorbing all toxic agents. Activated charcoal should not be used following the accidental ingestion of petroleum distillates (e.g., cleaning fluid, furniture polish, gasoline, kerosene, paint thinner), alkali ingestion, acid ingestion, ethanol intoxication, or ingestions of turpentine, methanol, cyanide, ferrous sulfate or other iron salts, lithium, or certain inorganic salts because there is no documented benefit to charcoal treatment. If sorbitol containing charcoal products are administered, vomiting could occur, which could worsen the clinical outcome of a caustic ingestion. The clinician should also note that the use of charcoal should not preclude the use of other emergency treatments or antidotes used following specific poisonings.
Multiple-dose charcoal oral suspension should not be used in the presence of a GI obstruction. If bowel sounds are absent (i.e., ileus), cathartics should not be administered, and repeat dosages of charcoal should be avoided. Commonly cited reasons for administering cathartics along with charcoal include the prevention of charcoal-induced constipation and to decrease the bioavailability of the toxic ingestant. Based on available data in position statements, charcoal is not sufficiently constipating in these treatment scenarios and cathartics alone or with charcoal do not decrease the bioavailability of the ingestant. Therefore the need for concurrent administration of cathartics with charcoal in the treatment of acute ingestions remains unproven and is not recommended. Repeated administration of sorbitol or saline cathartics (e.g., magnesium citrate) with charcoal beyond 1 dose is not recommended because electrolyte imbalance (e.g., hypernatremia, hypermagnesemia) and dehydration may occur.
Patients should not take non-prescription forms of activated charcoal if they have the following history of GI disease, except on advice of a health care prescriber. Constipation or other GI conditions may be exacerbated by the continual presence of charcoal in the GI tract. Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal, thus increasing the clearance of therapeutic agents and potentially rendering them less effective. The Food and Drug Administration has not evaluated the safety and efficacy of activated charcoal capsules or tablets; these products are not intended to diagnose, treat, cure, or prevent any disease. Efficacy in treating or preventing flatulence and diarrhea are not established. Charcoal is not effective in preventing traveler's diarrhea and should not be used to treat diarrhea caused by infection.
CharcoCaps Homeopathic Formula caplets contain sulfur, alkaloids from cinchona officionalis (cinchona tree), and Lycopodium clavatum (club moss) in addition to charcoal. Do not use this product in patients with sensitivity to cinchona alkaloids, including those patients with quinine hypersensitivity or quinidine hypersensitivity, which may exhibit cross-reactivity to this combination homeopathic product. Other herbal or natural components may also cause sensitivities, including bronchial asthma in susceptible individuals.
Activated charcoal suspension is used during pregnancy only if the potential benefit justifies the potential risk. No teratogenic effects have been noted in animals, nor has the suspension been reported to cause birth defects or other problems in human pregnancy. Activated charcoal suspension is an important element of emergent care for poisonings and toxic ingestions. Because marketed charcoal tablets and capsules are not regulated as drugs, but as dietary supplements; self-treatment during pregnancy with these products without advice of a qualified health care professional is not recommended.
No precautions are known in the lactating woman taking activated charcoal who is breast-feeding her infant. In general, charcoal suspension is considered compatible with breast-feeding when treatment is clearly needed. Because marketed charcoal tablets and capsules are not regulated as drugs, but as dietary supplements; self-treatment during lactation with these products (without advice of a qualified health care professional) is not recommended. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally administered drug, healthcare providers are encouraged to report the adverse effect to the FDA.
Patients who have had recent abdominal or pelvic surgery or other major surgery should not use charcoal except on advice of their health care prescriber.
For treatment of flatulence* or for the treatment of non-infectious diarrhea* associated with indigestion and intestinal gas (as an adsorbent):
NOTE: The FDA has not evaluated activated charcoal for these purposes; these products are not intended to diagnose, treat, cure, or prevent any disease.
NOTE: Available in a variety of strengths from many manufacturers of nutritional supplements. Consumers should also note that rigid quality control standards are not required and substantial variability can occur in both the potency and the purity of these products.
Oral dosage (CharcoCaps capsules):
Adults: 520 mg (2 capsules) PO after meals or as needed, may be repeated hourly. Maximum dosage 4.16 g PO (16 capsules) per day ( manufacturer recommendations). One study has found that activated charcoal does not exhibit appreciable effect on the liberation of flatulence or abdominal symptoms related to excessive sulfur-gases from the intestine. Efficacy in treating or preventing flatulence or diarrhea is not established.
For treatment of overdose or poisoning in acute, toxic oral ingestion or parenteral overdosage when the toxin has been totally absorbed:
NOTE: Charcoal is not indicated for overdose or poisoning due to ingestion of turpentine, corrosives, such as alkalies and strong acids, or petroleum distillates, such as kerosene, gasoline, paint thinner, or cleaning fluid or furniture polish. Charcoal may not be as effective in adsorbing low molecular weight substances such as aliphatic alcohols (e.g., ethanol, isopropanol, methanol), metals (e.g., iron, lead, mercury), and elements (e.g., lithium).
Oral dosage (activated charcoal aqueous suspension):
Adults: 50 to 100 g PO every 4 to 6 hours as needed.
Adolescents: 50 to 100 g PO every 4 to 6 hours as needed.
Children: 25 to 50 g PO every 4 to 6 hours as needed.
Infants: 1 g/kg/dose PO every 4 to 6 hours as needed.
Oral dosage (activated charcoal with sorbitol suspension):
Adults: 50 g PO as a single dose. Charcoal suspension formulated with sorbitol is not recommended for multiple doses. If additional doses are required, use the aqueous suspension.
Adolescents: 50 g PO as a single dose. Charcoal suspension formulated with sorbitol is not recommended for multiple doses. If additional doses are required, use the aqueous suspension.
Oral dosage (activated charcoal powder for oral solution):
Adults: 20 to 30 g PO; repeat dose immediately, if possible.
Children and Adolescents: 20 to 30 g PO; repeat dose immediately, if possible.
For reducing the absorption of direct-acting oral anticoagulants (DOACs) to assist in apixaban reversal, betrixaban reversal, dabigatran reversal, edoxaban reversal, and rivaroxaban reversal in patients with life-threatening or uncontrolled bleeding*:
Oral dosage:
Adults: 50 grams by mouth once to reduce the absorption of DOACs that were ingested within the preceding 2 to 4 hours is recommended as an option by the American College of Cardiology expert consensus.
Maximum Dosage Limits:
Specific maximum dosage information is not available. Individualize dosage based on the size of the patient and the estimated weight of the drug or chemical ingested.
Patients with Hepatic Impairment Dosing
No dosage adjustments are needed.
Patients with Renal Impairment Dosing
No dosage adjustments are needed.
*non-FDA-approved indication
Acarbose: (Major) Charcoal is an intestinal adsorbent which may reduce the effects of the alpha-glucosidase inhibitors (e.g., acarbose or miglitol). Charcoal should not be taken concomitantly. Advise patients to avoid charcoal dietary supplements if possible. If charcoal must be taken, then separate times of administration (e.g., administer the alpha-glucosidase inhibitor at least 1 hour before or 4 hours after a charcoal dose) to limit interactions. Monitor blood glucose.
Acetaminophen: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Aspirin, ASA; Caffeine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Aspirin, ASA; Caffeine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Aspirin: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Aspirin; Diphenhydramine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Caffeine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Caffeine; Dihydrocodeine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Caffeine; Pyrilamine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Chlorpheniramine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Chlorpheniramine; Dextromethorphan: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Chlorpheniramine; Phenylephrine : (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Codeine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Dextromethorphan: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Dextromethorphan; Doxylamine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Dextromethorphan; Guaifenesin; Pseudoephedrine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Dextromethorphan; Phenylephrine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Dextromethorphan; Pseudoephedrine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Diphenhydramine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Guaifenesin; Phenylephrine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Hydrocodone: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Ibuprofen: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Oxycodone: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Pamabrom; Pyrilamine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Phenylephrine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetaminophen; Pseudoephedrine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Acetylcysteine: (Moderate) Administration of activated charcoal and oral acetylcysteine at the same time may cause a reduction in acetylcysteine (NAC) absorption. There are conflicting data as to whether the reduced bioavailability of NAC is clinically significant during the treatment of drug overdoses. In the case of a mixed drug overdose activated charcoal may be indicated for use along with NAC. However, if activated charcoal has been administered, lavage before administering oral NAC treatment. Activated charcoal adsorbs acetylcysteine in vitro and may do so in patients and thereby may reduce its effectiveness.
Alpha-glucosidase Inhibitors: (Major) Charcoal is an intestinal adsorbent which may reduce the effects of the alpha-glucosidase inhibitors (e.g., acarbose or miglitol). Charcoal should not be taken concomitantly. Advise patients to avoid charcoal dietary supplements if possible. If charcoal must be taken, then separate times of administration (e.g., administer the alpha-glucosidase inhibitor at least 1 hour before or 4 hours after a charcoal dose) to limit interactions. Monitor blood glucose.
Aripiprazole: (Major) Aripiprazole absorption is reduced when activated charcoal is coadministered within an hour of a 15 mg dosage, resulting in a decrease in aripiprazole AUC and Cmax by roughly 50%. Concomitant administration of aripiprazole with activated charcoal is not recommended. However, administration of activated charcoal may be appropriate in certain aripiprazole overdose situations.
Atenolol: (Major) Charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal. While the reduction in absorption is beneficial in treating overdoses of drugs and toxins, activated charcoal dietary supplements used for flatulence or other purposes may reduce the effectiveness of certain beta-blocking agents (e.g., atenolol, sotalol, nadolol, pindolol). Use of activated charcoal is best limited to situations of drug overdose. Activated charcoal (single dose, 50-gram) reduced the absorption of therapeutic doses of atenolol, pindolol, and sotalol by > 90%. Repeat charcoal doses may decrease the entero-hepatic recycling of some of these agents. Repeated doses increased the elimination of sotalol and nadolol.
Atenolol; Chlorthalidone: (Major) Charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal. While the reduction in absorption is beneficial in treating overdoses of drugs and toxins, activated charcoal dietary supplements used for flatulence or other purposes may reduce the effectiveness of certain beta-blocking agents (e.g., atenolol, sotalol, nadolol, pindolol). Use of activated charcoal is best limited to situations of drug overdose. Activated charcoal (single dose, 50-gram) reduced the absorption of therapeutic doses of atenolol, pindolol, and sotalol by > 90%. Repeat charcoal doses may decrease the entero-hepatic recycling of some of these agents. Repeated doses increased the elimination of sotalol and nadolol.
Benzhydrocodone; Acetaminophen: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Butalbital; Acetaminophen: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Butalbital; Acetaminophen; Caffeine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Butalbital; Acetaminophen; Caffeine; Codeine: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Carbamazepine: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal. Use of activated charcoal as a dietary supplement for flatulence or other purposes is likely to decrease the effectiveness of agents like carbamazepine.
Cardiac glycosides: (Moderate) Decreased serum digoxin concentrations have been reported in patients who received digoxin and activated charcoal. Measure serum digoxin concentrations before initiating charcoal. Continue monitoring during concomitant treatment and increase the digoxin dose by 20% to 40% as necessary and clinically indicated. Patients who ingest dietary supplements containing activated charcoal should be aware that the effectiveness of digoxin may be decreased, and it is advisable to have the patient check with their health care professional before regularly taking such supplements.
Chenodiol: (Major) Activated charcoal, which is available in some dietary supplements, has been shown to adsorb bile acids in vitro and is expected to interfere with the efficacy of chenodiol. Concurrent use is not recommended.
Chlorpromazine: (Major) Phenothiazine absorption is reduced when coadministered with activated charcoal. Concomitant administration of phenothiazines and activated charcoal dietary supplements is not recommended. Activated charcoal may be appropriate in phenothiazine overdose situations, as charcoal absorbs the phenothiazines and also enhances drug elimination.
Codeine; Phenylephrine; Promethazine: (Major) Phenothiazine absorption is reduced when coadministered with activated charcoal. Concomitant administration of phenothiazines and activated charcoal dietary supplements is not recommended. Activated charcoal may be appropriate in phenothiazine overdose situations, as charcoal absorbs the phenothiazines and also enhances drug elimination.
Codeine; Promethazine: (Major) Phenothiazine absorption is reduced when coadministered with activated charcoal. Concomitant administration of phenothiazines and activated charcoal dietary supplements is not recommended. Activated charcoal may be appropriate in phenothiazine overdose situations, as charcoal absorbs the phenothiazines and also enhances drug elimination.
Dapsone: (Moderate) Patients who ingest activated charcoal as a dietary supplement for flatulence or other purposes should be aware that the effectiveness of other regularly taken medications (e.g., dapsone) may be decreased. In some drug overdoses, such as dapsone overdose, multiple-doses of charcoal slurries are an effective therapeutic adjunct. Repeat doses may decrease the entero-hepatic recycling of some of these agents.
Desogestrel; Ethinyl Estradiol: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Dienogest; Estradiol valerate: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Digoxin: (Moderate) Decreased serum digoxin concentrations have been reported in patients who received digoxin and activated charcoal. Measure serum digoxin concentrations before initiating charcoal. Continue monitoring during concomitant treatment and increase the digoxin dose by 20% to 40% as necessary and clinically indicated. Patients who ingest dietary supplements containing activated charcoal should be aware that the effectiveness of digoxin may be decreased, and it is advisable to have the patient check with their health care professional before regularly taking such supplements.
Drospirenone: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Drospirenone; Estetrol: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Drospirenone; Estradiol: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Drospirenone; Ethinyl Estradiol: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Drospirenone; Ethinyl Estradiol; Levomefolate: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Elagolix; Estradiol; Norethindrone acetate: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Estradiol; Levonorgestrel: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Estradiol; Norethindrone: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Estradiol; Norgestimate: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Ethinyl Estradiol; Norelgestromin: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Ethinyl Estradiol; Norethindrone Acetate: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Ethinyl Estradiol; Norgestrel: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Ethotoin: (Major) Charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal. In some drug overdoses (e.g., fosphenytoin or phenytoin), multiple-doses of charcoal slurries may be an effective therapeutic adjunct. Patients who ingest activated charcoal in non-overdose situations for flatulence or other purposes should be aware that the effectiveness of other regularly taken medications (e.g., oral phenytoin) might be decreased.
Ethynodiol Diacetate; Ethinyl Estradiol: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Etonogestrel; Ethinyl Estradiol: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Fluphenazine: (Major) Phenothiazine absorption is reduced when coadministered with activated charcoal. Concomitant administration of phenothiazines and activated charcoal dietary supplements is not recommended. Activated charcoal may be appropriate in phenothiazine overdose situations, as charcoal absorbs the phenothiazines and also enhances drug elimination.
Fosphenytoin: (Major) Charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal. In some drug overdoses (e.g., fosphenytoin or phenytoin), multiple-doses of charcoal slurries may be an effective therapeutic adjunct. Patients who ingest activated charcoal in non-overdose situations for flatulence or other purposes should be aware that the effectiveness of other regularly taken medications (e.g., oral phenytoin) might be decreased.
Hydantoins: (Major) Charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal. In some drug overdoses (e.g., fosphenytoin or phenytoin), multiple-doses of charcoal slurries may be an effective therapeutic adjunct. Patients who ingest activated charcoal in non-overdose situations for flatulence or other purposes should be aware that the effectiveness of other regularly taken medications (e.g., oral phenytoin) might be decreased.
Ipecac: (Contraindicated) Ipecac should not be administered if activated charcoal is the preferred treatment modality. Ipecac may delay administration of activated charcoal by up to 2.5 hours due to vomiting. If ipecac is the preferred treatment, activated charcoal should not be administered concomitantly because it can adsorb ipecac and reduce the chance of emesis. Once ipecac-induced emesis has occurred and been considered complete, activated charcoal may be administered, if needed.
Leflunomide: (Major) Activated charcoal can bind with leflunomide and enhance its clearance from the systemic circulation via intestinal trapping. Because the active metabolite of leflunomide, M1, has a prolonged half-life, staggering the administration times of each agent will not prevent this drug interaction. After 24 hours of activated charcoal administration, the levels of M1, the active metabolite of leflunomide, are reduced by approximately 37%. This effective means of gastrointestinal dialysis has actually been used therapeutically in patients with leflunomide toxicity. Charcoal is used as an alternative to cholestyramine in the drug elimination procedure for leflunomide.
Leuprolide; Norethindrone: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Levonorgestrel: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Levonorgestrel; Ethinyl Estradiol: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Levonorgestrel; Ethinyl Estradiol; Ferrous Fumarate: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Miglitol: (Major) Charcoal is an intestinal adsorbent which may reduce the effects of the alpha-glucosidase inhibitors (e.g., acarbose or miglitol). Charcoal should not be taken concomitantly. Advise patients to avoid charcoal dietary supplements if possible. If charcoal must be taken, then separate times of administration (e.g., administer the alpha-glucosidase inhibitor at least 1 hour before or 4 hours after a charcoal dose) to limit interactions. Monitor blood glucose.
Mycophenolate: (Major) Activated charcoal binds bile acids and can interrupt enterohepatic recirculation of mycophenolic acid and thus, reduce mycophenolic acid systemic exposure. Concurrent use of any drug that may interfere with enterohepatic recirculation of MPA such as activated charcoal is not recommended.
Nadolol: (Major) Charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal. While the reduction in absorption is beneficial in treating overdoses of drugs and toxins, activated charcoal dietary supplements used for flatulence or other purposes may reduce the effectiveness of certain beta-blocking agents (e.g., atenolol, sotalol, nadolol, pindolol). Use of activated charcoal is best limited to situations of drug overdose. Activated charcoal (single dose, 50-gram) reduced the absorption of therapeutic doses of atenolol, pindolol, and sotalol by > 90%. Repeat charcoal doses may decrease the entero-hepatic recycling of some of these agents. Repeated doses increased the elimination of sotalol and nadolol.
Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Norethindrone: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Norethindrone; Ethinyl Estradiol: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Norethindrone; Ethinyl Estradiol; Ferrous fumarate: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Norgestimate; Ethinyl Estradiol: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Norgestrel: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Olanzapine: (Major) Concomitant administration of olanzapine and activated charcoal is not recommended and is not expected to occur under normal clinical use. The Cmax and AUC of olanzapine were reduced by 60% when co-administered with activated charcoal. Co-administration with activated charcoal may be appropriate in an olanzapine overdose situation, especially since peak olanzapine levels do not occur until 6 hours after an oral ingestion. However, patients should avoid dietary supplements containing activated charcoal.
Olanzapine; Fluoxetine: (Major) Concomitant administration of olanzapine and activated charcoal is not recommended and is not expected to occur under normal clinical use. The Cmax and AUC of olanzapine were reduced by 60% when co-administered with activated charcoal. Co-administration with activated charcoal may be appropriate in an olanzapine overdose situation, especially since peak olanzapine levels do not occur until 6 hours after an oral ingestion. However, patients should avoid dietary supplements containing activated charcoal.
Olanzapine; Samidorphan: (Major) Concomitant administration of olanzapine and activated charcoal is not recommended and is not expected to occur under normal clinical use. The Cmax and AUC of olanzapine were reduced by 60% when co-administered with activated charcoal. Co-administration with activated charcoal may be appropriate in an olanzapine overdose situation, especially since peak olanzapine levels do not occur until 6 hours after an oral ingestion. However, patients should avoid dietary supplements containing activated charcoal.
Oral Contraceptives: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Perphenazine: (Major) Phenothiazine absorption is reduced when coadministered with activated charcoal. Concomitant administration of phenothiazines and activated charcoal dietary supplements is not recommended. Activated charcoal may be appropriate in phenothiazine overdose situations, as charcoal absorbs the phenothiazines and also enhances drug elimination.
Perphenazine; Amitriptyline: (Major) Phenothiazine absorption is reduced when coadministered with activated charcoal. Concomitant administration of phenothiazines and activated charcoal dietary supplements is not recommended. Activated charcoal may be appropriate in phenothiazine overdose situations, as charcoal absorbs the phenothiazines and also enhances drug elimination.
Phenothiazines: (Major) Phenothiazine absorption is reduced when coadministered with activated charcoal. Concomitant administration of phenothiazines and activated charcoal dietary supplements is not recommended. Activated charcoal may be appropriate in phenothiazine overdose situations, as charcoal absorbs the phenothiazines and also enhances drug elimination.
Phenytoin: (Major) Charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal. In some drug overdoses (e.g., fosphenytoin or phenytoin), multiple-doses of charcoal slurries may be an effective therapeutic adjunct. Patients who ingest activated charcoal in non-overdose situations for flatulence or other purposes should be aware that the effectiveness of other regularly taken medications (e.g., oral phenytoin) might be decreased.
Pindolol: (Major) Charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal. While the reduction in absorption is beneficial in treating overdoses of drugs and toxins, activated charcoal dietary supplements used for flatulence or other purposes may reduce the effectiveness of certain beta-blocking agents (e.g., atenolol, sotalol, nadolol, pindolol). Use of activated charcoal is best limited to situations of drug overdose. Activated charcoal (single dose, 50-gram) reduced the absorption of therapeutic doses of atenolol, pindolol, and sotalol by > 90%. Repeat charcoal doses may decrease the entero-hepatic recycling of some of these agents. Repeated doses increased the elimination of sotalol and nadolol.
Prochlorperazine: (Major) Phenothiazine absorption is reduced when coadministered with activated charcoal. Concomitant administration of phenothiazines and activated charcoal dietary supplements is not recommended. Activated charcoal may be appropriate in phenothiazine overdose situations, as charcoal absorbs the phenothiazines and also enhances drug elimination.
Promethazine: (Major) Phenothiazine absorption is reduced when coadministered with activated charcoal. Concomitant administration of phenothiazines and activated charcoal dietary supplements is not recommended. Activated charcoal may be appropriate in phenothiazine overdose situations, as charcoal absorbs the phenothiazines and also enhances drug elimination.
Promethazine; Dextromethorphan: (Major) Phenothiazine absorption is reduced when coadministered with activated charcoal. Concomitant administration of phenothiazines and activated charcoal dietary supplements is not recommended. Activated charcoal may be appropriate in phenothiazine overdose situations, as charcoal absorbs the phenothiazines and also enhances drug elimination.
Promethazine; Phenylephrine: (Major) Phenothiazine absorption is reduced when coadministered with activated charcoal. Concomitant administration of phenothiazines and activated charcoal dietary supplements is not recommended. Activated charcoal may be appropriate in phenothiazine overdose situations, as charcoal absorbs the phenothiazines and also enhances drug elimination.
Relugolix; Estradiol; Norethindrone acetate: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Segesterone Acetate; Ethinyl Estradiol: (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal; repeat doses may decrease the enterohepatic recycling of some drugs. Activated charcoal dietary supplements may have the potential to reduce the effectiveness of oral contraceptives. Data clearly demonstrating this interaction are not available. Ovulatory potential was studied during the use of two monophasic oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal to treat diarrhea in women. None of eleven women ovulated. Repeated charcoal treatment, when administered 3 hours after but at least 12 hours before pill intake, did not alter oral contraceptive efficacy.
Sotalol: (Major) Charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal. While the reduction in absorption is beneficial in treating overdoses of drugs and toxins, activated charcoal dietary supplements used for flatulence or other purposes may reduce the effectiveness of certain beta-blocking agents (e.g., atenolol, sotalol, nadolol, pindolol). Use together is best limited to situations of drug overdose. Activated charcoal (single dose, 50-gram) reduced the absorption of therapeutic doses of atenolol, pindolol, and sotalol by > 90%. Repeat charcoal doses may decrease the entero-hepatic recycling of some of these agents. Repeated doses increased the elimination of sotalol and nadolol.
Teriflunomide: (Major) Activated charcoal can bind with teriflunomide and enhance its clearance from the systemic circulation via intestinal trapping. Because teriflunomide has a prolonged half-life, staggering the administration times of each agent will not prevent this drug interaction. After 11 days of activated charcoal administration, teriflunomide concentrations are reduced by approximately 98%. Activated charcoal is used to facilitate teriflunomide elmination from the body when clinically necessary.
Theophylline, Aminophylline: (Major) Charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal. When taken as a dietary supplement for flatulence or other purposes, activated charcoal will decrease the effectiveness of other regularly taken medications (e.g., theophylline, aminophylline) by reducing oral drug absorption. Activated charcoal (repeat dosing) is an important therapeutic adjunct in severe theophylline drug overdoses; repeat doses also increase the elimination of the drug. (Major) Note that charcoal exerts a nonspecific effect, and many medications can be adsorbed by activated charcoal. When taken as a dietary supplement for flatulence or other purposes, activated charcoal will decrease the effectiveness of other regularly taken medications (e.g., theophylline or aminophylline) by increasing drug clearance. Activated charcoal is an important therapeutic adjunct in theophylline drug overdoses, but otherwise should be avoided in non-emergent use.
Thioridazine: (Major) Phenothiazine absorption is reduced when coadministered with activated charcoal. Concomitant administration of phenothiazines and activated charcoal dietary supplements is not recommended. Activated charcoal may be appropriate in phenothiazine overdose situations, as charcoal absorbs the phenothiazines and also enhances drug elimination.
Thiothixene: (Major) The absorption of thiothixene is reduced when coadministered with activated charcoal. Concomitant administration is not recommended, however, coadministration with activated charcoal may be appropriate in certain overdose situations.
Tramadol; Acetaminophen: (Minor) Activated charcoal binds many drugs within the gut. Administering charcoal dietary supplements at the same time as a routine acetaminophen dosage would be expected to interfere with the analgesic and antipyretic efficacy of acetaminophen. Charcoal is mostly used in the setting of acetaminophen overdose; however, patients should never try to treat an acetaminophen overdose with charcoal dietary supplements. Advise patients to get immediate medical attention for an acetaminophen overdose.
Trifluoperazine: (Major) Phenothiazine absorption is reduced when coadministered with activated charcoal. Concomitant administration of phenothiazines and activated charcoal dietary supplements is not recommended. Activated charcoal may be appropriate in phenothiazine overdose situations, as charcoal absorbs the phenothiazines and also enhances drug elimination.
Ursodeoxycholic Acid, Ursodiol: (Major) Activated charcoal, which is available in dietary supplements, has been shown to adsorb bile acids in vitro and is expected to interfere with the efficacy of ursodeoxycholic acid, ursodiol. Concurrent use is not recommended.
Charcoal "adsorbs" a variety of drugs and chemicals. It is important to note that adsorption represents the physical binding of a molecule to the surface of charcoal particles. Bound particles can also "desorb" unless the ratio of charcoal to toxin is extremely high. Charcoal also can adsorb vitamins and minerals from the GI tract, but the amounts are insignificant when the drug is administered for acute treatment.
Charcoal will bind nearly all organic compounds except for caustic alkalis, mineral acids, or ethanol or methanol. The drug is not effective in adsorbing inorganic molecules such as cyanide, ferrous sulfate and other iron products, or lithium and should not be used in the treatment of poisoning with these agents.
Activated charcoal has also been used topically to decrease the odor of foul-smelling ulcers or wounds. Charcoal is often added to filter devices that can be added to ostomy care pouches for absorbing odors related to intestinal stomas.
Pharmacokinetics:
Activated charcoal is administered orally. Because activated charcoal does not cross the lining of the GI tract, it is not metabolized. Unchanged drug is excreted in the feces.