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| [[Image:Aktivkohlerp.jpg|thumb|Activated carbon]]
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| '''Activated carbon''', also called '''activated charcoal''' or '''activated coal''', is a general term which covers [[carbon]] material mostly derived from [[charcoal]]. For all three variations of the name, "activated" is sometimes substituted by "active". By any name, it is a material with an exceptionally high [[surface area]]. Just one [[gram]] of activated carbon has a surface area of approximately 500 m<sup>2</sup>, typically determined by [[nitrogen]] gas [[adsorption]], and includes a large amount of microporosity. Sufficient activation for useful applications may come solely from the high surface area, though often further chemical treatment is used to enhance the absorbing properties of the material.
| | |indicationType=treatment |
| | |blackBoxWarningTitle=<b><span style="color:#FF0000;">TITLE</span></b> |
| | |blackBoxWarningBody=<i><span style="color:#FF0000;">Condition Name:</span></i> (Content) |
| | |offLabelAdultGuideSupport=There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of Activated carbon in adult patients. |
| | |offLabelAdultNoGuideSupport=There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of Activated carbon in adult patients. |
| | |fdaLIADPed=Actidose® with Sorbitol is not recommended in children less than one year of age. |
| | |offLabelPedGuideSupport=There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of Activated carbon in pediatric patients. |
| | |offLabelPedNoGuideSupport=There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of Activated carbon in pediatric patients. |
| | |contraindications=There are no known absolute contraindications to the use of activated charcoal, however, it is not an equally effective adsorbent for all toxins. It should be used with caution, if at all, in patients who have ingested corrosive agents since the activated charcoal may obscure endoscopic visualization of esophageal and gastric lesions produced by the corrosive. The use of a cathartic with activated charcoal may not be advised if a patient has significant fluid or electrolyte abnormalities. Actidose® with Sorbitol should not be used in infants due to the possibility of excessive catharsis. Young children should not receive cathartic doses of sorbitol unless hospitalized and under the immediate care of a physician. |
| | |warnings=If patient has been given ipecac syrup, DO NOT give ACTIDOSE® WITH SORBITOL or ACTIDOSE®-AQUA until after last vomiting episode. Do not use in persons who are not fully conscious. Do not use this product unless directed by a health professional, if turpentine, corrosives, such as alkalies (lye) and strong acids, or petroleum distillates, such as kerosene, gasoline, paint thinner, cleaning fluid or furniture polish, have been ingested. This product is not recommended for use in children weighing less than 32 kg, or during multiple dose activated charcoal therapy since excessive catharsis and significant fluid and electrolyte abnormalities may occur. |
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| ==Production==
| | Keep this and all drugs out of the reach of children. |
| It can be produced in two different processes from a variety of carbonaceous source materials, e.g. nutshells, [[wood]], [[coal]]. It can be produced using one of the two following processes:
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| # '''Physical reactivation''': The precursor is developed into activated carbons using gases. This is generally done by using one of or combining the following processes:
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| #* ''Carbonization'': Material with carbon content is [[pyrolysis|pyrolysed]] at temperatures in the range 600-900 °C, in absence of air (usually in inert atmosphere with gases like argon)
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| #* ''Activation/Oxidation'': Raw material or [[carbonization|carbonised]] material is exposed to oxidizing atmospheres (carbon dioxide, oxygen, or steam) at temperatures above 250 °C, usually in the temperature range 600-1200 °C.
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| # '''Chemical activation''': Impregnation with chemicals such as [[acid]]s like phosphoric acid or bases like potassium hydroxide, sodium hydroxide or salts like zinc chloride, followed by carbonization at temperatures in the range 450-900 °C. It is believed that the carbonization / activation step proceeds simultaneously with the chemical activation. This technique can be problematic in some cases because, for example, [[zinc]] trace residues may remain in the end product. However, chemical activation is preferred over physical activation owing to the lower temperatures and shorter time needed for activating material.
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| [[Saturation (chemistry)|Saturated]] activated carbon can be regenerated by heating.
| | Do not use Actidose® with Sorbitol or Actidose®-Aqua in any person known to have a rare autosomal recessive genetic intolerance to fructose. Do not use Actidose® with Sorbitol in patients who are dehydrated. Actidose® with Sorbitol may cause excessive diarrhea. |
| | ===Precautions=== |
| | Actidose® with Sorbitol and Actidose®-Aqua should be used in a supervised medical facility or under the direction of a physician or poison control center. |
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| ==Properties==
| | Actidose® with Sorbitol and Actidose®-Aqua are adjuncts in the management of poisoning emergencies. Prior to the use of activated charcoal, proper basic life support measures must be implemented as well as the appropriate gastric emptying technique if indicated. |
| A [[gram]] of activated carbon can have a surface area in excess of 500 [[metre|m]]², with 1500 m² being readily achievable. For comparison, a [[tennis court]] is about 260 m². Carbon [[aerogel]]s, while more expensive, have even higher surface areas, and are used in special applications.
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| Under an [[electron microscope]], the structure of activated carbon looks a little like ribbons of paper which have been crumpled together, intermingled with wood chips. There are a great number of nooks and crannies, and many areas where flat surfaces of [[graphite]]-like material run parallel to each other, separated by only a few [[metre|nanometers]] or so. These [[micro]]pores provide superb conditions for [[adsorption]] to occur, since adsorbing material can interact with many surfaces simultaneously. Tests of adsorption behaviour are usually done with [[nitrogen]] gas at 77 [[kelvin|K]] under high [[vacuum]], but in everyday terms activated carbon is perfectly capable of producing the equivalent, by adsorption from its environment, liquid water from [[steam]] at 100°[[Celsius|C]] and a pressure of 1/10,000 of an [[atmosphere (unit)|atmosphere]].
| | When Actidose® with Sorbitol or Actidose®-Aqua are used to treat a poisoning emergency, the patient and health care providers should be aware that activated charcoal will produce black stools. These stools may be diarrhetic and may persist for several hours. |
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| Physically, activated carbon binds materials by [[Van der Waals force]] or [[London dispersion force]].
| | Actidose® with Sorbitol may produce a profound cathartic effect and proper attention should be given to the patient’s fluid and electrolyte needs. Actidose® with Sorbitol should be used cautiously in patients receiving multiple dose activated charcoal. If Actidose® with Sorbitol is used at each dosage interval, profound catharsis may develop which could result in dehydration, hypotension and significant electrolyte and fluid abnormalities. |
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| Activated carbon does not bind well to certain chemicals, including [[alcohol]]s, [[glycol]]s, [[ammonia]], strong [[acid]]s and [[base (chemistry)|bases]], [[metal]]s and most [[inorganic]]s, such as [[lithium]], [[sodium]], [[iron]], [[lead]], [[arsenic]], [[fluorine]], and [[boric acid]]. Activated carbon does absorb [[iodine]] very well and in fact the iodine number, mg/g, ([[ASTM]] D28 Standard Method test) is used as an indication of total surface area.
| | A study conducted in healthy adult human volunteers who ingested therapeutic amounts of activated charcoal and sorbitol resulted in severe prolonged diarrhea, but no significant changes were noted in serum electrolytes or osmolality, BUN, or the metabolic profile as compared to the control.8 |
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| Activated carbon can be used as a substrate for the application of various chemicals to improve the adsorptive capacity for some inorganic (and problematic organic) compounds such as hydrogen sulphide (<math>H_2S</math>), ammonia (<math>NH_3</math>), formaldehyde (<math>HCOH</math>), radio-isotopes (Iodine-131) and mercury (Hg). This property is known as [[chemisorption]].
| | Gastrointestinal obstruction from activated charcoal may occur as a consequence of toxin-induced antiperistaltic effects. Actidose® with Sorbitol and Actidose®-Aqua should be used cautiously in patients who have been exposed to toxins which interfere with gastrointestinal tract peristalsis (i.e., anticholinergics, opioids, etc.). Bowel sounds should be frequently monitored to assess peristaltic action, especially in patients undergoing multiple dose activated charcoal therapy. |
| | |clinicalTrials=Activated charcoal with sorbitol has produced severe hypernatremic dehydration when used in excessive amounts in pediatric patients.25, 27 |
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| ==Classifications==
| | Aspiration of activated charcoal has been reported to produce airway obstruction and a limited number of fatalities have occurred. 28,29,30,31 Bronchiolitis obliterans resulting in death has developed several weeks after the aspiration of activated charcoal.32 |
| Activated carbons are complex products which are difficult to classify on the basis of their behaviour, surface characteristics and preparation methods. However, some broad classification is made for general purpose based on their physical characteristics.
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| ===Powdered activated carbon (PAC)===
| | Gastrointestinal obstruction associated with the use of multiple dose activated charcoal therapy has been reported.33 An overdose of carbamazepine was responsible for the antiperistaltic effects which led to bowel obstruction. |
| Traditionally, active carbons are made in particular form as powders or fine granules less than 1.0 mm in size with an average diameter between .15 and .25 mm. {{Fact|date=March 2007}} Thus they present a large internal surface with a small diffusion distance. PAC is made up of crushed or ground carbon particles, 95–100% of which will pass through a designated mesh sieve or sieve. Granular activated carbon is defined as the activated carbon being retained on a 50-mesh sieve (0.297 mm) and PAC material as finer material, while ASTM classifies particle sizes corresponding to an 80-mesh sieve (0.177 mm) and smaller as PAC. PAC is not commonly used in a dedicated vessel, owing to the high headloss that would occur. PAC is generally added directly to other process units, such as raw water intakes, rapid mix basins, clarifiers, and gravity filters.
| | |useInPregnancyFDA=Safe use during pregnancy and lactation has not been established. Actidose® with Sorbitol and Actidose®-Aqua should be used during pregnancy or lactation only if the potential benefit justifies the potential risk. No teratogenic effects have been noted in rabbits or rats. |
| | |useInNursing=Actidose® should be used during pregnancy or lactation only if the potential benefit justifies the potential risk. |
| | |useInPed=Actidose® with Sorbitol is not recommended in children less than one year of age. |
| | |administration=*Oral. |
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| ===Granulated activated carbon (GAC)===
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| Granulated activated carbon has a relatively larger particle size compared to powdered activated carbon and consequently, presents a smaller external surface. Diffusion of the adsorbate is thus an important factor. These carbons are therefore preferred for all adsorption of gases and vapours as their rate of diffusion are faster. Granulated carbons are used for water treatment, deodourisation and separation of components of flow system. GAC can be either in the granular form or extruded. GAC is designated by sizes such as 8x20, 20x40, or 8x30 for liquid phase applications and 4x6, 4x8 or 4x10 for vapour phase applications. A 20x40 carbon is made of particles that will pass through a U.S. Standard Mesh Size No. 20 sieve (0.84 mm) (generally specified as 85% passing) but be retained on a U.S. Standard Mesh Size No. 40 sieve (0.42 mm) (generally specified as 95% retained). AWWA (1992) B604 uses the 50-mesh sieve (0.297 mm) as the minimum GAC size. The most popular aqueous phase carbons are the 12x40 and 8x30 sizes because they have a good balance of size, surface area, and headloss characteristics.
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| ===Pelleted activated carbon===
| | |monitoring=Monitor bowl sounds frequently to assess the |
| Consists of extruded and cylindrical shaped activated carbon with diameters from 0.8 to 5 mm. These are mainly used for gas phase applications because of their low pressure drop, high mechanical strength and low dust content.
| | |alcohol=Alcohol-Activated carbon interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication. |
| | | }} |
| ===Impregnated carbon===
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| Porous carbons containing several types of inorganic impregnant such as iodine, silver, cation such as Al, Mn, Zn, Fe, Li, Ca have also been prepared for specific application in air pollution control especially in museums and galleries. Silver loaded activated carbon is used as an adsorbent for purifications of domestic water. Drinking water can be obtained from natural water by treating the natural water with a mixture of activated carbon and flocculating agent Al(OH)<sub>3</sub>. Impregnated carbons are also used for the adsorption of H<sub>2</sub>S and mercaptans. Adsorption rates for H<sub>2</sub>S as high as 50% by weight have been reported.
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| ===Polymers coated carbon===
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| This is a process by which a porous carbon can be coated with a biocompatible polymer to give a smooth and permeable coat without blocking the pores. The resulting carbon is useful for hemoperfusion. Hemoperfusion is a treatment technique in which large volumes of the patient's blood are passed over an absorbent substance in order to remove toxic substances from the blood.
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| ===Other===
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| Activated carbon is also available in special forms such as cloths and fibres.
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| ==Properties of activated carbon==
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| * Iodine Number
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| It is the most fundamental parameter used to characterize activated carbon performance.
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| It is a measure of activity level (higher number indicates higher degree of activation).
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| It is a measure of the micropore content of the activated carbon (0 to 20 Å, or up to 2 [[nanometer|nm]]) by adsorption of iodine from solution.
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| It is equivalent to surface area of activated carbon between 900 m²/g and 1100 m²/g.
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| It is the standard measure for liquid phase applications.
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| * Apparent density
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| Higher density provides greater volume activity and normally indicates better quality activated carbon.
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| * Hardness/abrasion number
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| It is a measure of the activated carbon’s resistance to attrition.
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| It is important indicator of activated carbon to maintain its physical integrity and withstand frictional forces imposed by backwashing, etc. There are large differences in the hardness of activated carbons, depending on the raw material and activity level.
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| * Ash content
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| It reduces the overall activity of activated carbon.
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| It reduces the efficiency of reactivation.
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| The metals (Fe<sub>2</sub>O<sub>3</sub>) can leach out of activated carbon resulting in discoloration. Acid/water soluble ash content is more significant than total ash content.
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| * Carbon tetrachloride activity
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| Measurement of the porosity of an activated carbon by the adsorption of saturated carbon tetrachloride vapour.
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| * Particle size distribution
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| The finer the particle size of an activated carbon, the better the access to the surface area and the faster the rate of adsorption kinetics. In vapour phase systems this needs to be considered against pressure drop, which will affect energy cost. Careful consideration of particle size distribution can provide significant operating benefits.
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| ==Examples of adsorption== | |
| * ''[[Heterogeneous catalysis]]''
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| The most commonly encountered form of chemisorption in industry, occurs when a solid [[catalyst]] interacts with a gaseous feedstock, the reactant/s. The adsorption of reactant/s to the catalyst surface creates a chemical bond, altering the electron density around the reactant molecule and allowing it to undergo reactions that would not normally be available to it.
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| * ''[[Adsorption refrigeration]]''
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| Adsorption refrigeration and heat pump cycles rely on the adsorption of a refrigerant gas into an adsorbent at low pressure and subsequent desorption by heating. The adsorbent acts as a "chemical compressor" driven by heat and is, from this point of view, the "pump" of the system. It consists of a solar collector, a condenser or heat-exchanger and an evaporator that is placed in a refrigerator box. The inside of the collector is lined with an adsorption bed packed with activated carbon absorbed with methanol. The refrigerator box is insulated filled with water. The activated carbon can adsorb a large amount of methanol vapours in ambient temperature and desorb it at a higher temperature (around 100 degrees Celsius). During the daytime, the sunshine irradiates the collector, so the collector is heated up and the methanol is desorbed from the activated carbon. In desorption, the liquid methanol adsorbed in the charcoal heats up and vaporizes. The methanol vapour condenses and is stored in the evaporator.
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| At night, the collector temperature decreases to the ambient temperature, and the charcoal adsorbs the methanol from the evaporator. The liquid methanol in the evaporator vaporizes and adsorbs the heat from the water contained in the trays. Since adsorption is a process of releasing heat, the collector must be cooled efficiently at night. As mentioned above, the adsorption refrigeration system operates in an intermittent way to produce the refrigerating effect.
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| Helium gas can also be 'pumped' by thermally cycling activated carbon 'sorption pumps' between 4 Kelvin and higher temperatures. An example of this is to provide the cooling power for the Oxford Instruments AST series dilution refrigerators. <sup>3</sup>He vapour is pumped from the surface of the dilute phase of a mixture of liquid <sup>4</sup>He and its isotope <sup>3</sup>He. The <sup>3</sup>He is adsorbed onto the surfaces of the carbon at low temperature (typically <4K), the regeneration of the pump between 20 - 40K returns the <sup>3</sup>He to the concentrated phase of the liquid mixture. Cooling occurs at the interface between the two liquid phases as <sup>3</sup>He 'evaporates' across the phase boundary. If more than one pump is present in the system a continuous flow of gas and hence constant cooling power can be obtained, by having one sorption pump regenerating while the other is pumping. Systems such as this allow temperatures as low as 10mK (0.01 Kelvin) to be obtained with very few moving parts.
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| * ''[[Surface_Enhanced_Raman_Spectroscopy | Surface enhanced Raman spectroscopy ]] [SERS]''
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| SERS is totally dependent on the interactions between a usually metalic enhancing surface and the adsorbed analytes and leads to the amplification of the usually very weak emission of raman radiation—characteristic of the molecule which is adsorbed. If the surface plasmon wave of the enhancing surface is of a specific frequency [depending on the excitation laser used] super enhancement can be achieved and is known as SERRS—Surface Enhanced Raman Resonance Spectroscopy.
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| ==Applications==<!-- This section is linked from [[Air stripping]] -->
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| Activated carbon is used in [[air pollution|gas purification]], [[extractive metallurgy|metal extraction]], [[water purification]], [[medicine]], [[sewage treatment]], [[air filter]]s in [[gas mask]]s and [[filter mask]]s, filters in compressed air and many other applications.
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| === Environmental applications ===
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| Carbon [[adsorption]] has numerous applications in removing [[pollutant]]s from air or water streams both in the field and in industrial processes such as:
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| * Spill cleanup
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| * [[Groundwater]] [[remediation]]
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| * [[Drinking water]] [[filtration]]
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| * [[Air Purification]]
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| * [[Volatile organic compound]]s capture from [[painting]], [[dry cleaning]] and other processes
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| === Medical applications ===
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| Activated carbon is used to treat [[poison]]ings and [[overdose]]s following oral [[ingestion]]. It prevents absorption of the poison by the [[gastrointestinal tract]]. In cases of suspected poisoning, medical personnel either administer activated carbon on the scene or at a hospital's [[emergency department]]. Dosing is usually empirical at 1 gram/kg of body weight, usually given every 2 hours. Activated carbon has become the treatment of choice for many poisonings, and other decontamination methods such as [[syrup of ipecac|ipecac]]-induced [[emesis]] or [[stomach pump]]s are now used rarely.
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| Mechanisms of action:
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| *Binding of the toxin to prevent stomach and intestinal absorption. Binding is reversible so a [[cathartic]] such as [[sorbitol]] may be added as well.
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| *It interrupts the [[enterohepatic circulation]] of some drugs/toxins and their [[metabolites]]
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| *Allows certain drugs/toxins to be drawn out of the blood and bind to the charcoal in the [[intestine]] - a kind of "gut dialysis"
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| Incorrect application (e.g. into the lungs) results in [[pulmonary aspiration]] which can sometimes be fatal if immediate medical treatment is not initiated.<ref name="Chest1989-Elliott">{{cite journal | author = Elliott C, Colby T, Kelly T, Hicks H | title = Charcoal lung. Bronchiolitis obliterans after aspiration of activated charcoal | journal = Chest | volume = 96 | issue = 3 | pages = 672-4 | year = 1989 | id = PMID 2766830}}</ref> The use of activated charcoal is contraindicated when the ingested substance is an acid, an alkali, or a petroleum product.
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| For pre-hospital use, it comes in plastic tubes or bottles, commonly 12.5 or 25 grams, pre-mixed with water. The trade names include InstaChar, SuperChar, Actidose, and Liqui-Char, but it is commonly called simply Activated Charcoal.
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| As an [[over-the-counter drug]], it is often used to treat mild [[diarrhea]].
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| === Gas purification ===
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| Filters with activated carbon are usually used in compressed air and gas purification to remove [[oil]] vapours, odours, and other [[hydrocarbon]]s from the air. The most common designs use a 1 stage or 2 stage filtration principle where activated carbon is embedded inside the filter media. Activated charcoal is also used in [[spacesuit]] [[Primary Life Support System]]s.
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| === Vodka purification ===
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| Activated carbon filters can be used to filter [[vodka]] of [[organic compound|organic]] impurities. Since the activated carbon does not bind well to alcohols, the percentage of [[ethanol]] is not significantly affected, but the carbon will bind to and remove many organic impurities which can affect color, taste, and odor. Passing an organically impure vodka through an activated carbon filter 6-12 times (or through the same number of filters in one pass) will result in vodka with an identical alcohol content and significantly increased organic purity, as judged by odor and taste. <ref>[http://www.ohmygoditburns.com/wordpress/index.php?p=4 ''Practical Applications of the Philosopher's Stone'', Oh My God It Burns!]</ref>
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| === In traditional medicine ===
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| In the classic Chinese novel [[Journey to the West]] - chapter 69, one of the ingredients used to cure the mysterious malady of the king was 'soot scraped from a cooking pot'.
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| ==Footnotes==
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| <div class="references-small">
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| {{reflist|2}}
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| </div>
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| ==References==
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| *Engber, Daniel (Nov. 28, 2005). [http://www.slate.com/id/2131130/ "How Does Activated Carbon Work?"]. ''[[Slate (magazine)|Slate]]''.
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| ==See also==
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| *[[Carbon black]]
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| *[[Carbon filtering]]
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| *[[Zeocarbon]]
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| == External links ==
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| *[http://www.activecarbonfilters.com/Activecarbon/index.htm Activated Carbon Supplier]
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| *[http://www.ext.nodak.edu/extpubs/h2oqual/watsys/ae1029w.htm Activated Carbon Filtration for Household Water Supplies]
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| *[http://www.chemvironcarbon.com/en/carbon/activated-carbon Activated Carbon 101]
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| *[http://www.tigg.com/ACTIVATED-CARBON/activated-carbon.html Activated Carbon - What is it, How Does It Work?]
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| [[Category:Carbon forms]]
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| [[Category:Filters]]
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| [[Category:Toxicology]]
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| [[bg:Активен въглен]]
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| [[cs:Aktivní uhlí]]
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| [[de:Aktivkohle]]
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| [[es:Carbón activado]]
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| [[fr:Charbon activé]]
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| [[hr:Aktivni ugljen]]
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| [[nl:Actieve kool]]
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| [[ja:活性炭]]
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| [[pl:Węgiel aktywny]]
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| [[pt:Carvão ativado]]
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| [[ru:Активированный уголь]]
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| [[sk:Aktívne uhlie]]
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| [[fi:Aktiivihiili]]
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| [[sv:Aktivt kol]]
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| [[th:ถ่านปลุกฤทธิ์]]
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| [[vi:Than hoạt tính]]
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| [[tr:Aktif karbon]]
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| [[uk:Активоване вугілля]]
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| [[zh:活性炭]]
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Overview
Activated carbon is {{{aOrAn}}} {{{drugClass}}} that is FDA approved for the treatment of {{{indication}}}. Common adverse reactions include {{{adverseReactions}}}.
Adult Indications and Dosage
FDA-Labeled Indications and Dosage (Adult)
There is limited information regarding Activated carbon FDA-Labeled Indications and Dosage (Adult) in the drug label.
Off-Label Use and Dosage (Adult)
Guideline-Supported Use
There is limited information regarding Off-Label Guideline-Supported Use of Activated carbon in adult patients.
Non–Guideline-Supported Use
There is limited information regarding Off-Label Non–Guideline-Supported Use of Activated carbon in adult patients.
Pediatric Indications and Dosage
FDA-Labeled Indications and Dosage (Pediatric)
Actidose® with Sorbitol is not recommended in children less than one year of age.
Off-Label Use and Dosage (Pediatric)
Guideline-Supported Use
There is limited information regarding Off-Label Guideline-Supported Use of Activated carbon in pediatric patients.
Non–Guideline-Supported Use
There is limited information regarding Off-Label Non–Guideline-Supported Use of Activated carbon in pediatric patients.
Contraindications
There are no known absolute contraindications to the use of activated charcoal, however, it is not an equally effective adsorbent for all toxins. It should be used with caution, if at all, in patients who have ingested corrosive agents since the activated charcoal may obscure endoscopic visualization of esophageal and gastric lesions produced by the corrosive. The use of a cathartic with activated charcoal may not be advised if a patient has significant fluid or electrolyte abnormalities. Actidose® with Sorbitol should not be used in infants due to the possibility of excessive catharsis. Young children should not receive cathartic doses of sorbitol unless hospitalized and under the immediate care of a physician.
Warnings
If patient has been given ipecac syrup, DO NOT give ACTIDOSE® WITH SORBITOL or ACTIDOSE®-AQUA until after last vomiting episode. Do not use in persons who are not fully conscious. Do not use this product unless directed by a health professional, if turpentine, corrosives, such as alkalies (lye) and strong acids, or petroleum distillates, such as kerosene, gasoline, paint thinner, cleaning fluid or furniture polish, have been ingested. This product is not recommended for use in children weighing less than 32 kg, or during multiple dose activated charcoal therapy since excessive catharsis and significant fluid and electrolyte abnormalities may occur.
Keep this and all drugs out of the reach of children.
Do not use Actidose® with Sorbitol or Actidose®-Aqua in any person known to have a rare autosomal recessive genetic intolerance to fructose. Do not use Actidose® with Sorbitol in patients who are dehydrated. Actidose® with Sorbitol may cause excessive diarrhea.
Precautions
Actidose® with Sorbitol and Actidose®-Aqua should be used in a supervised medical facility or under the direction of a physician or poison control center.
Actidose® with Sorbitol and Actidose®-Aqua are adjuncts in the management of poisoning emergencies. Prior to the use of activated charcoal, proper basic life support measures must be implemented as well as the appropriate gastric emptying technique if indicated.
When Actidose® with Sorbitol or Actidose®-Aqua are used to treat a poisoning emergency, the patient and health care providers should be aware that activated charcoal will produce black stools. These stools may be diarrhetic and may persist for several hours.
Actidose® with Sorbitol may produce a profound cathartic effect and proper attention should be given to the patient’s fluid and electrolyte needs. Actidose® with Sorbitol should be used cautiously in patients receiving multiple dose activated charcoal. If Actidose® with Sorbitol is used at each dosage interval, profound catharsis may develop which could result in dehydration, hypotension and significant electrolyte and fluid abnormalities.
A study conducted in healthy adult human volunteers who ingested therapeutic amounts of activated charcoal and sorbitol resulted in severe prolonged diarrhea, but no significant changes were noted in serum electrolytes or osmolality, BUN, or the metabolic profile as compared to the control.8
Gastrointestinal obstruction from activated charcoal may occur as a consequence of toxin-induced antiperistaltic effects. Actidose® with Sorbitol and Actidose®-Aqua should be used cautiously in patients who have been exposed to toxins which interfere with gastrointestinal tract peristalsis (i.e., anticholinergics, opioids, etc.). Bowel sounds should be frequently monitored to assess peristaltic action, especially in patients undergoing multiple dose activated charcoal therapy.
Adverse Reactions
Clinical Trials Experience
Activated charcoal with sorbitol has produced severe hypernatremic dehydration when used in excessive amounts in pediatric patients.25, 27
Aspiration of activated charcoal has been reported to produce airway obstruction and a limited number of fatalities have occurred. 28,29,30,31 Bronchiolitis obliterans resulting in death has developed several weeks after the aspiration of activated charcoal.32
Gastrointestinal obstruction associated with the use of multiple dose activated charcoal therapy has been reported.33 An overdose of carbamazepine was responsible for the antiperistaltic effects which led to bowel obstruction.
Postmarketing Experience
There is limited information regarding Activated carbon Postmarketing Experience in the drug label.
Drug Interactions
There is limited information regarding Activated carbon Drug Interactions in the drug label.
Use in Specific Populations
Pregnancy
Pregnancy Category (FDA):
Safe use during pregnancy and lactation has not been established. Actidose® with Sorbitol and Actidose®-Aqua should be used during pregnancy or lactation only if the potential benefit justifies the potential risk. No teratogenic effects have been noted in rabbits or rats.
Pregnancy Category (AUS):
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Activated carbon in women who are pregnant.
Labor and Delivery
There is no FDA guidance on use of Activated carbon during labor and delivery.
Nursing Mothers
Actidose® should be used during pregnancy or lactation only if the potential benefit justifies the potential risk.
Pediatric Use
Actidose® with Sorbitol is not recommended in children less than one year of age.
Geriatic Use
There is no FDA guidance on the use of Activated carbon in geriatric settings.
Gender
There is no FDA guidance on the use of Activated carbon with respect to specific gender populations.
Race
There is no FDA guidance on the use of Activated carbon with respect to specific racial populations.
Renal Impairment
There is no FDA guidance on the use of Activated carbon in patients with renal impairment.
Hepatic Impairment
There is no FDA guidance on the use of Activated carbon in patients with hepatic impairment.
Females of Reproductive Potential and Males
There is no FDA guidance on the use of Activated carbon in women of reproductive potentials and males.
Immunocompromised Patients
There is no FDA guidance one the use of Activated carbon in patients who are immunocompromised.
Administration and Monitoring
Administration
Monitoring
Monitor bowl sounds frequently to assess the
IV Compatibility
There is limited information regarding the compatibility of Activated carbon and IV administrations.
Overdosage
There is limited information regarding Activated carbon overdosage. If you suspect drug poisoning or overdose, please contact the National Poison Help hotline (1-800-222-1222) immediately.
Pharmacology
There is limited information regarding Activated carbon Pharmacology in the drug label.
Mechanism of Action
There is limited information regarding Activated carbon Mechanism of Action in the drug label.
Structure
There is limited information regarding Activated carbon Structure in the drug label.
Pharmacodynamics
There is limited information regarding Activated carbon Pharmacodynamics in the drug label.
Pharmacokinetics
There is limited information regarding Activated carbon Pharmacokinetics in the drug label.
Nonclinical Toxicology
There is limited information regarding Activated carbon Nonclinical Toxicology in the drug label.
Clinical Studies
There is limited information regarding Activated carbon Clinical Studies in the drug label.
How Supplied
There is limited information regarding Activated carbon How Supplied in the drug label.
Storage
There is limited information regarding Activated carbon Storage in the drug label.
Images
Drug Images
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Package and Label Display Panel
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Patient Counseling Information
There is limited information regarding Activated carbon Patient Counseling Information in the drug label.
Precautions with Alcohol
Alcohol-Activated carbon interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
Brand Names
There is limited information regarding Activated carbon Brand Names in the drug label.
Look-Alike Drug Names
There is limited information regarding Activated carbon Look-Alike Drug Names in the drug label.
Price
References
The contents of this FDA label are provided by the National Library of Medicine.