What is the role of activated charcoal in the treatment of calcium channel blocker (CCB) toxicity?

Updated: Jan 04, 2021
  • Author: B Zane Horowitz, MD, FACMT; Chief Editor: Michael A Miller, MD  more...
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Answer

Activated charcoal has been demonstrated to significantly absorb immediate-release medications within 1 hour of ingestion and extended-release medications as long as 4 hours after ingestion. [4] If the ingested dose is known, a 10:1 charcoal-to-drug weight ratio can be used to calculate the optimal dose of activated charcoal to completely bind the ingested drug. [27] Otherwise, a 1-g/kg initial dose is recommended.

The potential benefit of decreased drug absorption must be weighed against the risk of gastric distention with subsequent aspiration. Any conditions predisposing to aspiration (eg, altered mental status, nausea, seizures) are contraindications to administration of activated charcoal. In patients with severe toxicity, interventions such as antiemetics and intubation with satisfactory sedation should be performed before administration of activated charcoal via a nasogastric tube.


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