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Overview

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This medicine contains an important and useful components, as it consists of
Pirfenidoneis available in the market in concentration

Name

Activated Charcoal

Precaution

- **Pregnancy and Breastfeeding**: Activated charcoal is generally considered **safe during pregnancy** (Category C), as it is not absorbed into the bloodstream. However, its use should be limited to situations where the benefits outweigh potential risks, particularly in cases of poisoning. It is not known to be secreted in breast milk, and while its use is considered safe, caution is still advised. - **Gastrointestinal Concerns**: Activated charcoal can cause **gastrointestinal irritation**, such as **nausea**, **vomiting**, and **constipation**. In rare cases, it may lead to more severe issues like **bowel obstruction** or **perforation**, particularly when administered in large quantities or in patients with pre-existing gastrointestinal conditions like **ileus** or **intestinal obstruction**. Care should be taken when used in individuals with a history of **gastrointestinal surgery**. - **Aspiration Risk**: The risk of **aspiration** is a serious concern, particularly when administering activated charcoal in patients who are not fully conscious or who have altered mental status. Aspiration can lead to **aspiration pneumonia** and should be avoided. In these cases, activated charcoal should be administered with caution, and **endotracheal intubation** should be considered to prevent aspiration in unconscious or semi-conscious patients. - **Monitoring**: There is no routine monitoring required for the use of activated charcoal, but patients should be observed for any signs of **gastrointestinal discomfort**, and **vital signs** should be monitored. In the case of overdose or severe poisoning, additional treatments, such as **antidotes** or **supportive care**, should be considered.

Indication

- **Acute Poisoning**: Activated charcoal is most commonly used in the **emergency treatment of poisoning** following the ingestion of various toxins, including **drugs** (e.g., **acetaminophen**, **benzodiazepines**, **barbiturates**), **chemicals**, and **pesticides**. It works by adsorbing the toxin in the gastrointestinal tract, preventing its absorption into the bloodstream. - It is particularly effective if given within **1 hour** of ingestion, as the toxin is more likely to be in the stomach and upper gastrointestinal tract, where activated charcoal can effectively bind to it. - Activated charcoal is not effective for all toxins; it is ineffective for substances like **alcohols**, **heavy metals** (e.g., lead, iron), and **corrosive substances**. - **Gastrointestinal Decontamination**: Activated charcoal is sometimes used for **gastrointestinal decontamination** in settings where other treatment options are either unavailable or not suitable. - **Off-label Uses**: While its primary use is for poisoning, activated charcoal has been used off-label in **cholestasis** (reduced bile flow), **hyperbilirubinemia**, and to absorb **gases** produced by the digestive system in conditions like **flatulence** or **bloating**, although these uses are not well-established and are generally not first-line treatments.

Contra indication

- **Gastrointestinal Perforation**: Activated charcoal should be **contraindicated** in patients with a **known or suspected** **gastrointestinal perforation** (e.g., gastric or intestinal perforation). The charcoal could potentially exacerbate the perforation, leading to serious complications such as **peritonitis** or **sepsis**. - **Inability to Protect Airway**: Since activated charcoal poses a risk of aspiration, it is **contraindicated** in patients who are unable to **protect their airway**, such as those who are unconscious or have a reduced level of consciousness. In these cases, the risk of aspiration pneumonia or **pulmonary aspiration** outweighs any potential benefit. - **Corrosive Substance Ingestion**: It is contraindicated in patients who have ingested **corrosive substances** (e.g., acids, alkalis) because activated charcoal can cause further damage or complicate the management of these types of ingestions. - **Age and Sensitivity**: In **neonates** and **infants**, use of activated charcoal should be avoided unless absolutely necessary, as the gastrointestinal tract in these populations is more sensitive and can be easily irritated.

Side Effect

- **Common Side Effects**: - **Constipation**: This is the most common side effect of activated charcoal. It is usually mild but can become problematic if prolonged use or large doses are given. - **Black Stools**: Activated charcoal typically causes **blackened stools**. This is a harmless side effect, but it may be mistaken for **GI bleeding**, so it is important to inform patients and healthcare providers. - **Nausea and Vomiting**: Some patients may experience **nausea**, **vomiting**, or **gastrointestinal discomfort**, especially if the charcoal is taken in large quantities or without adequate fluids. - **Serious Side Effects**: - **Aspiration Pneumonia**: If activated charcoal is aspirated into the lungs, it can cause **aspiration pneumonia** or other pulmonary complications. This is a serious risk, especially if the patient is unconscious or semi-conscious. - **Bowel Obstruction**: Rarely, activated charcoal can lead to **bowel obstruction** or **ileus**, particularly in patients who have pre-existing gastrointestinal conditions or if large amounts are ingested. - **Electrolyte Imbalance**: Long-term use of activated charcoal may cause **electrolyte imbalances**, though this is very rare with short-term or acute use. - **Management of Side Effects**: To mitigate constipation, patients can be encouraged to take **laxatives** or **increase fiber intake**. For patients who develop signs of aspiration pneumonia, immediate treatment with **antibiotics** and respiratory support should be provided.

Pregnancy Category ID

0

Mode of Action

Activated charcoal works primarily through **adsorption**, where it binds to toxins, drugs, and other harmful substances in the gastrointestinal tract. The surface area of activated charcoal is highly porous, providing a large surface area for adsorption. Once the toxin binds to the charcoal, it is unable to be absorbed through the **intestinal wall** and is eliminated in the stool. - **Mechanism of Action in Poisoning**: Activated charcoal's ability to bind a wide range of toxins makes it an effective treatment for many types of poisoning. Its effect is localized to the gastrointestinal tract, where it prevents the toxin from entering systemic circulation. This prevents or reduces the absorption of the poison, effectively reducing its harmful effects on the body. - **Molecular Interactions**: The effectiveness of activated charcoal depends on the **molecular size** of the toxin, its **solubility**, and the time since ingestion. Some toxins, such as **heavy metals** and **alcohols**, do not bind well to activated charcoal, which is why it is not effective for all poisons. - **Not Absorbed Systemically**: Activated charcoal itself is not absorbed into the bloodstream; it acts **locally** in the gastrointestinal tract. This makes it a relatively **safe** intervention, though it should be used with care to avoid aspiration or other gastrointestinal complications.

Interaction

- **Drug-Drug Interactions**: Activated charcoal can **adsorb** and reduce the absorption of certain **medications**. Drugs that have been shown to interact with activated charcoal include: - **Acetaminophen**: It may reduce the effectiveness of acetaminophen when given concurrently, though activated charcoal can still be useful in overdose management if given within the first hour. - **Anticoagulants**: Activated charcoal can reduce the absorption of **warfarin** and other anticoagulants, which may interfere with their therapeutic effects. Care should be taken in patients on anticoagulant therapy. - **Antibiotics**: **Tetracycline antibiotics** (e.g., doxycycline) and **quinolone antibiotics** (e.g., ciprofloxacin) may be adsorbed by activated charcoal, reducing their absorption and effectiveness. - **Other drugs**: **Digoxin**, **theophylline**, and **tricyclic antidepressants** can also have reduced absorption if charcoal is administered at the same time. - **Food and Drink Interactions**: While food does not significantly affect the activity of activated charcoal, it should generally be given with **water** to help with its dispersion in the gastrointestinal tract. - **Alcohol**: Alcohol does not interfere with the effectiveness of activated charcoal, but it can impact the overall management of poisoning if not addressed concurrently.

Pregnancy Category Note

Information not available

Adult Dose

- **Acute Poisoning**: - The typical **oral dose** of activated charcoal for adults is **50 to 100 grams** for most cases of **acute poisoning**, usually administered as a single dose or multiple doses, depending on the toxin involved. - **Multiple Doses**: In some cases, **multiple-dose activated charcoal** (MDAC) is used, where **25-50 grams** is administered every **2 hours** for up to 24 hours in cases of slow-release or enterohepatic recirculation toxins. - **Gastrointestinal Decontamination**: For **gastrointestinal decontamination**, the standard dose is typically **50-100 grams**, followed by continued monitoring for any signs of **toxicity** or complications.

Child Dose

- **For Poisoning**: - The usual **oral dose** for children is **1 gram per kilogram** of body weight, up to a maximum of **50 grams** for smaller children. - For children over **12 years of age**, the dosage can be similar to adults (50 to 100 grams). - **Multiple-Dose Activated Charcoal (MDAC)**: In cases of sustained-release or life-threatening poisoning, MDAC may be used, with dosing adjusted based on **age**, **weight**, and **clinical judgment**. This medication is a vital tool in emergency toxicology, and while generally safe, careful attention to proper use is crucial to avoid complications.

Renal Dose

- **Renal Impairment**: There are no specific dose adjustments required for patients with **renal impairment**, as activated charcoal works primarily in the gastrointestinal tract and does not affect kidney function directly. However, it should be used with caution in patients with **severe renal dysfunction** to avoid complications such as **bowel perforation** or aspiration pneumonia, which could exacerbate the patient's condition.

Administration

Information not available