Data Sheet

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Carbosorb S

Activated Charcoal U.S.P. 50g with 150mL Sorbitol Solution 70% B.P in Purified Water B.P

Composition

An aqueous suspension of Activated Charcoal U.S.P. 50g and 150mL Sorbitol Solution 70% B.P in Purified Water B.P to 300ml.

Actions

Activated charcoal is an adsorbent used to remove drugs from the gastrointestinal tract as a treatment for poisoning. Its mechanism of action is by physical adsorption of drugs and toxic agents onto its surface.

It is effective in the adsorption of the vast majority of drugs, and most chemicals.

Due to the wide range of compounds for which AC is effective it is easier to list those for which it is not indicated - these include:

Indications

Contraindications

CARBOSORB is contra-indicated when bowel sounds are absent and where the toxic compound is not effectively bound by activated charcoal (see above).

Precautions

CARBOSORB will adsorb medications taken for therapeutic purposes. Parental administration may be required. Women taking oral contraceptives should be advised to use an alternative method of contraception until the beginning of the next period.

The cathartic effect of sorbitol may produce diarrhoea resulting in electrolyte disturbance or dehydration. The clinical condition of patients, particularly children, should therefore be monitored closely if treated with CARBOSORB S.

Use in Pregnancy:

There have been no documented problems related to the use of activated charcoal in pregnancy.

Activated charcoal is not absorbed from the gastrointestinal tract and is not expected to produce a problem during pregnancy.

The cathartic effect of sorbitol may cause diarrhoea resulting in electrolyte disturbances or dehydration.

CARBOSORB S should only be used in pregnancy if the potential benefits outweigh the risk of therapy.

Adverse Effects

The presence of sorbitol in CARBOSORB S may produce diarrhoea disturbing fluid and electrolyte balance. Multiple doses should not be administered as this has caused serious fluid and electrolyte abnormalities.

The major adverse effect of activated charcoal is inadvertent aspiration of charcoal which may lead to asphyxia or bronchiolitis obliterans, while the sorbitol component of CARBOSORB S is likely to cause fluid shift into the lung increasing pulmonary toxicity. If compromised the airway should be protected with endotracheal intubation.

Faecal discolouration occurs frequently. Black stools may be utilised as a diagnostic sign of gastrointestinal transit.

Dosage and Administration

The usual dose for single-dose activated charcoal treatment is 50 - 100g for adults and 1 - 2g/kg for children. CARBOSORB S is formulated to be a single dose unit for an average adult. CARBOSORB S is administered orally (see note on paediatric use).

CARBOSORB S is most effective if administered while a toxic ingestant is still in the stomach. As liquids transit more quickly than solids, the "window of opportunity" for administering CARBOSORB S is less for liquids. CARBOSORB S is useful if administered within half an hour of ingestion of liquids, and usually up to four hours following ingestion of solid substances or dose forms. These timings do vary depending on the characteristics of the ingestant.

Due to aspiration risk nasogastric intubation to instil activated charcoal should not be routinely attempted. It may be used in obtunded patients provided the airway is protected with endotracheal intubation. In other situations this route should be adopted only if all following conditions apply:

All cases should be discussed with a Poisons Information Centre or Emergency Physician prior to attempting this procedure.

In the exceptional circumstances where activated charcoal is administered via nasogastric intubation it is recommended that the charcoal-filled bag be massaged gently prior to administration and fitted to a Vygon 350 tube, sizes: french gauge 27, 30, 33 and 36. The suspension is administered by tightly rolling the bag up, forcing the suspension into the tube.

Paediatric use

Children may object to drinking the black, gritty solution. They should therefore be coaxed to co-operate in a firm, friendly manner, preferably in the presence of a care-giver. Use of a straw with an opaque, covered container may increase acceptance. As a last resort a flavouring agent (e.g. a flavoured drink) may be added to increase palatability. It should however be noted that this will decrease the effectiveness of the activated charcoal. Only in exceptional circumstances should activated charcoal be administered to a child via a nasogastric tube (see under dosage and administration).

Package Quantities

CARBOSORB S is contained in a PVC bag with a fitting for direct connection to an orogastric or nasogastric tube.

INFORMATION FOR HEALTH PROFESSIONALS