Activated Charcoal

Liverpool Hospital Emergency Department


Single dose activated Charcoal (SDAC) – as an adsorbing agent for appropriate  poisons with appropriate toxidromes (protected airway or airway not at risk) and risk of significant toxicity 

Multi dose activated Charcoal (MDAC) – as an enhanced elimination method for  drugs with enterohepatic circulation / gastrointestinal dialysis 

  • Drugs where MDAC can be considered are Carbamazepine / Colchicine /  Dapsone / Barbiturates / Quinine / Theophylline / Phenytoin / Warfarin 


  • Carbosorb 0.2g/ml (50g/250ml) 

Dosage and Administration 


  • 50g (1g/kg paediatric up to maximum 50g) orally or via NG/OGT in intubated  patients
  • In children can be mixed with ice-cream to improve taste
  • Give within 2 hours of estimated time of ingestion
  • May be given within 4 hours of ingestion for large ingestions / severe  poisonings / modified release preparations
  • If intubated can be given any time after ingestion 

MDAC (seek advice from Toxicologist) 

  • Repeat charcoal dosing 25g (0.5mg/kg in children) every 2 hours orally / NGT  / OGT or
  • 50g every 4 hours orally / NGT / OGT or
  • 12.5g/hr enteral feeding pump 

Side Effects: 

  • Aspiration with pneumonitis
  • Vomiting
  • Impaired absorption of other oral antidotes 

Pit Falls 

  • Drug must be in GIT
  • Benefit must outweigh risk of aspiration to patient or complication
  • If threatened airway must be intubated
  • The following drugs will not bind charcoal – Alcohols / Metals / Hydrocarbons / Acids  / Alkali
  • Avoid MDAC if there are no bowel sounds / ileus