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Actidose (Activated Charcoal) - Summary



Actidose® with Sorbitol: Actidose® with Sorbitol, ready-to-use activated charcoal suspension with sorbitol, contains 25 gm or 50 gm of activated charcoal, and 48 gm or 96 gm of sorbitol, respectively, in an aqueous suspension with a unique preservative system. Each milliliter contains 208 mg (0.208 gm) of activated charcoal and 400 mg (0.400 gm) of sorbitol. Sorbitol reduces the gritty sensation associated with activated charcoal, imparts a sweet taste which enhances patient compliance, and usually produces a cathartic effect. Actidose®-Aqua: Actidose®-Aqua, ready-to-use activated charcoal suspension, contains 15 gm, 25 gm or 50 gm of activated charcoal in an aqueous suspension with a unique preservative system. Each milliliter contains 208 mg (0.208 gm) of activated charcoal.

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 indicated in the management of many types of poisoning emergencies when a toxin has been ingested or when indicated for a limited number of systemic poisonings resulting from parenteral overdosage or when the toxin has been totally absorbed. If physiologic conditions are optimal,activated charcoal most effectively adsorbs toxins with a molecular weight of 100 - 1,000 Daltons (AMU's).1 Activated charcoal may not be as effective in adsorbing low molecular weight substances such as aliphatic alcohols (methanol, isopropanol, ethanol, etc.) metals (iron, lead, mercury, etc.) and elements such as lithium.2 Two animal studies have demonstrated that very toxic and low molecular weight cyanide compounds are adsorbed by activated charcoal.21,22 The use of activated charcoal in toxic emergencies involving these substances is not contraindicated. Many poisonings involve multiple substances, therefore, Actidose® with Sorbitol and Actidose®-Aqua may be effective in adsorbing some or all of the ingested toxins.

Adsorption of a toxin by activated charcoal can occur anywhere in the gastrointestinal tract. However, to use Actidose® with Sorbitol or Actidose®-Aqua most effectively it is important to administer it as soon as possible to the victim of an ingested exposure. The longer the delay between the ingestion of the toxin and administration of activated charcoal, the less effective it will be. If syrup of ipecac is being used to produce emesis, administration of Actidose® with Sorbitol or Actidose®-Aqua is customarily delayed until 30 - 60 minutes after conclusion of emesis. In a study which used syrup of ipecac, 60 ml, activated charcoal did not interfere with the emetic effect of syrup of ipecac.23

If gastric lavage is being used to facilitate stomach evacuation a single dose of activated charcoal can be administered in the earlystages of gastric lavage. If this technique is utilized, Actidose®-Aqua, which does not contain sorbitol, should be used. Upon completion of gastric lavage Actidose® with Sorbitol can be instilled via the lavage tube. The only disadvantage to the use of activated charcoal in thisfashion is that the gastric lavage returns will be black, thus making it difficult to evaluate what the patient ingested by visual examination. The primary advantage of this therapy is that activated charcoal can be administered early to the patient. The convenient packaging of Actidose® with Sorbitol and Actidose®-Aqua (except the 15 gm/72 ml size) in a squeeze bottle with a tapered nozzle expedites emergency treatment, allowing attachment to a gastric lavage tube and administration of contents.

The most common application of activated charcoal is in acute toxic exposures where Actidose® with Sorbitol and Actidose®-Aqua can adsorb toxins thereby preventing their absorption. Activated charcoal can also be used in some toxic emergencies when absorption is complete or exposure was via a parenteral route. This applicationusually involves repetitive or multiple doses of activated charcoal.

Multiple doses of activated charcoal may be useful in adsorbing toxins which undergo enterohepatic circulation.13 Drugs which are subject to biliary secretion such as digitoxin are constantly secreted into the gastrointestinal tract and are reabsorbed resulting in prolongedtoxicity. Frequent doses of activated charcoal can adsorb those toxins thereby preventing their reabsorption and enhancing toxin elimination through the gastrointestinal tract.

Multiple dose activated charcoal is also used in what is termed gastrointestinal dialysis.14 There are only a limited number of toxins which may be eliminated by this method. Clinical judgement and the toxin's pharmacokinetic parameters must be considered to determine the applicability of this treatment which is not universally applicable.24 The toxin passively diffuses along a concentration gradient between blood which is perfusing the gastrointestinal tract and the luminal fluids. The multiple doses of activated charcoal adsorb the toxin thereby preventing its reabsorption further maximizing the concentration gradient which permits diffusion of even more toxin into the gastric lumen. Compounds most effectively transferred by this mechanism are lipophilic, uncharged and not excessively bound to proteins. Phenobarbital and theophylline are examples of toxins which can be eliminated more rapidly by this method.15,16

Actidose® with Sorbitol should not be used in each dose of the multiple dose activated charcoal regimen unless it is necessary to produce catharsis. Actidose® with Sorbitol contains sorbitol which may produce excessive catharsis and resultant fluid and electrolyte problems if used at each dosing interval (see Precautions).9,25 Actidose®-Aqua should be used at dosage intervals when Actidose® with Sorbitol is not being used. CATHARTICS SHOULD BE USED CAUTIOUSLY AND ONLY INTERMITTENTLY DURING MULTIPLE DOSE ACTIVATED CHARCOAL THERAPY.

If catharsis of activated charcoal does not occur following the use of Actidose® with Sorbitol within 4 - 8 hours, an additional sorbitol dose of 1.5 gm/kg may be administered. Or, if desired, a saline cathartic such as magnesium citrate may be used if the patient's renal function is not impaired.

Actidose® with Sorbitol and Actidose®-Aqua are formulated in palatable vehicles which eliminate the need to add additional taste or consistency enhancers.The use of supplementary chemicals, syrups, or dairy products should be avoided since their addition may compromise the adsorptive capacity of Actidose® with Sorbitol and Actidose®-Aqua.

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Published Studies Related to Actidose (Activated Charcoal)

Efficacy of a simethicone, activated charcoal and magnesium oxide combination (Carbosymag(R)) in functional dyspepsia: results of a general practice-based randomized trial. [2011.06]
BACKGROUND: A simethicone, activated charcoal and magnesium oxide combination (Carbosymag((R))) has been used for almost 20 years in functional dyspepsia, but there is limited scientific evidence of efficacy. AIM: We evaluated the efficacy of Carbosymag((R)) in 18- to 49-year-old patients with functional dyspepsia... CONCLUSION: A simethicone, activated charcoal and magnesium oxide combination (Carbosymag((R))) was significantly more effective than a placebo on overall symptom intensity in dyspeptic patients consulting a general practitioner. Copyright (c) 2011 Elsevier Masson SAS. All rights reserved.

Effect of activated charcoal in reducing paracetamol absorption at a supra-therapeutic dose. [2010.10]
CONCLUSION: The tested AC was found to be able to reduce the absorption of the supratherapeutic dose of paracetamol.

Effect of activated charcoal dressings on healing outcomes of chronic wounds. [2010.05]
CONCLUSION: These clinical data indicate the potential usefulness of using activated charcoal impregnated with silver in the management of chronic wounds, even at the debridement stage. This dressing may help remove fluids and toxins that impair the healing process.

Oral activated charcoal prevents experimental cerebral malaria in mice and in a randomized controlled clinical trial in man did not interfere with the pharmacokinetics of parenteral artesunate. [2010.04.15]
BACKGROUND: Safe, cheap and effective adjunct therapies preventing the development of, or reducing the mortality from, severe malaria could have considerable and rapid public health impact. Oral activated charcoal (oAC) is a safe and well tolerated treatment for acute poisoning, more recently shown to have significant immunomodulatory effects in man.

Efficacy of an activated charcoal-simethicone combination in dyspeptic syndrome: results of a randomized prospective study in general practice. [2009.06]
AIM: The aim of this prospective, multicenter, randomized, placebo-controlled trial was to evaluate the efficacy of a commercial combination of simethicone and activated charcoal (Carbosylane) on dyspeptic symptoms in patients consulting a general practitioner... CONCLUSION: Among patients consulting a general practitioner for dyspeptic syndrome, 3 months of treatment with Carbosylane resulted in significant symptomatic improvement. The improvement was still evident 2 months after the end of treatment.

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Clinical Trials Related to Actidose (Activated Charcoal)

Phenytoin and Multidose Activated Charcoal [Completed]
Phenytoin is a medicine used to treat seizures. If too much is taken, patients have ill effects including sleepiness, unsteady gait, and eye problems. The amount of drug in their system can be measured in their blood. Charcoal is a medicine that can absorb phenytoin. We want to see if giving multiple doses of charcoal will quicken the removal of phenytoin from the blood. This is theorized to occur as charcoal absorbs phenytoin from across the intestines and then is secreted in the stool. Patients will be selected to receive either charcoal in multiple doses or no charcoal and their serum levels will be drawn repeatedly to follow their level. The different groups will then be compared to see if multidose charcoal does indeed increase the elimination of phenytoin from the body.

Study is to Determine the Extent of Pulmonary Absorption of Glycopyrrolate Following Dosing Via eFlow Nebulizer and Seebri Breezhaler With and Without Activated Charcoal in Subjects With Moderate to Severe Chronic Obstructive Pulmonary Disease (COPD) (GOLDEN 7) [Not yet recruiting]
The purpose of this research study is to determine the extent of pulmonary absorption of glycopyrrolate following dosing via eFlow nebulizer and Seebri Breezhaler with and without activated charcoal in subjects with moderate to severe chronic obstructive pulmonary disease (COPD).

A Clinical Study to Evaluate Z7200 (Budesonide/Formoterol) Pharmacokinetics Profile in Healthy Volunteers [Completed]
The pharmacokinetics study aims to evaluate the safety of Z7200 (budesonide/formoterol) in comparison with Symbicort Turbohaler (budesonide/formoterol), assessing the bioequivalence of the two products. Namely the study will compare the total systemic bioavailability (as an indicator of safety), and it will compare the pulmonary bioavailability (as a possible surrogate indicator of efficacy). This study will be performed in healthy subjects.

Evaluation of Oral Activated Charcoal on the Ability of an Antimalarial Drug to Kill Parasites in Malian Children With Mild Malaria [Completed]

- Malaria is caused by small parasites carried by some mosquitoes. People can get malaria if

an infected mosquito bites them. Malaria destroys red blood cells. Most malaria is mild, but some children develop severe malaria, which kills about 660,000 people annually. About 9 in 10 who die of malaria are Sub-Saharan African children, most under 5 years old. Scientists can save many lives if they find out how to prevent or relieve severe malaria. Objective:

- To know if a common medicine called activated charcoal can reduce severe malaria symptoms.


- Children 2 to 11 years old with mild malaria who live in Kenieroba, Mali.


- For the first 2 days and nights, participants will stay in the hospital.

- They will have their medical history taken, and a physical exam.

- Blood will be drawn from a thin tube inserted in their hand or forearm. This will be

done 3 times overall. A drop of blood will be taken from a finger prick 12 times overall.

- An antimalarial drug will be injected into the tube in the arm 4 times. Each time the

drug is given, participants will drink a small cup of either water or activated charcoal.

- For the following 3 days, participants will take an antimalarial pill.

- On day 7, participants will visit the hospital. A drop of blood from a finger prick

will be tested for malaria parasites.

Foster With or Without Charcoal Block or Aerochamber Plus [Completed]
The purpose of this study is to evaluate the systemic exposure of BDP, its metabolite beclomethasone 17-monopropionate (B17MP) and formoterol after inhalation of BDP/Formoterol 100/6 g pMDI combination (CHF1535) using the standard actuator and charcoal block technique or using a Spacer (AeroChamber Plus, Trudell) in comparison with inhalation using the standard actuator

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Page last updated: 2011-12-09

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