Drug: Actidose Aqua

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.

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Activated charcoal with sorbitol has produced severe hypernatremic dehydration when used in excessive amounts in pediatric patients.25,27 Aspiration of activated charcoal has been reported to produce airway obstruction and a limited number of fatalities have occurred.28,29,30,31 Bronchiolitis obliterans resulting in death has developed several weeks after the aspiration of activated charcoal.32 Gastrointestinal obstruction associated with the use of multiple dose activated charcoal therapy has been reported.33 An overdose of carba-mazepine was responsible for the antiperistaltic effects which led to bowel obstruction. Read the Actidose Aqua (activated charcoal suspension) Side Effects Center for a complete guide to possible side effectsLearn More »

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Prior to administration of Actidose with Sorbitol or Actidose-Aqua, shake the container thoroughly for a minimum of 30 seconds. After administration of either Actidose with Sorbitol or Actidose-Aqua, the container should be thoroughly rinsed with water and any residue should be administered to the patient to ensure that the entire dose has been delivered. Single Dose - Actidose-Aqua Under one year of age: 1gm/kg (5 ml/kg) 1 - 12 years of age: 25-50 gm (120-240 ml) Adults (over 12 yrs. of age): 50-100 gm (240-480 ml) Single Dose - Actidose with Sorbitol Under one year of age: DO NOT USE ACTIDOSE WITH SORBITOL IN CHILDREN LESS THAN ONE YEAR OF AGE. 1 - 12 years of age: DO NOT USE ACTIDOSE WITH SORBITOL 25 GM/120 ML IN CHILDREN WEIGHING LESS THAN 16 KG.   DO NOT USE ACTIDOSE WITH SORBITOL 50 GM/240 ML IN CHILDREN WEIGHING LESS THAN 32 KG Adults (over 12 yrs.): 50 gm [96 gm sorbitol] (240 ml) Multiple Dose - Actidose-Aqua Under one year of age: 1 gm/kg (5 ml/kg) q 4-6H (every 4-6 hrs) 1 - 12 years of age: 25-50 gm (120-240 ml) q 4-6H (every 4-6 hrs) Adults (over 12 yrs.): 50-100 gm (240-480 ml) q 4-6H (every 4-6 hrs) Multiple Dose - Actidose with Sorbitol   ACTIDOSE WITH SORBITOL IS NOT RECOMMENDED FOR CHILDREN OR ADULTS IN MULTIPLE DOSE ACTIVATED CHARCOAL THERAPY DUE TO EXCESSIVE CATHARTIC ACTION.

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No information provided. REFERENCES 25. J. Pediatrics. 1986; 109: 719-722 28. Vet Hum Toxicol. 1989; 31: 335 29. B Med J. 1988; 297: 459-460 30 NCMJ. 1990; 51: 79-80 31. Ann Emerg Med. 1981; 10: 528-529 32. Chest. 1989; 96: 672-674 33. J Emerg Med. 1986; 4: 401-407 Read the Actidose Aqua Drug Interactions Center for a complete guide to possible interactions Learn More »

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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, iso-propanol, 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 early stages 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 this fashion 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 application usually 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 prolonged toxicity. 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 reab-sorption 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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There are no known absolute contraindications to the use of activated charcoal, however, it is not an equally effective adsorbent for all toxins. It should be used with caution, if at all, in patients who have ingested corrosive agents since the activated charcoal may obscure endoscopic visualization of esophageal and gastric lesions produced by the corrosive. The use of a cathartic with activated charcoal may not be advised if a patient has significant fluid or electrolyte abnormalities. Actidose with Sorbitol should not be used in infants due to the possibility of excessive catharsis. Young children should not receive cathartic doses of sorbitol unless hospitalized and under the immediate care of a physician. Usage in children Actidose with Sorbitol is not recommended in children less than one year of age. Usage During Pregnancy Or Lactation Safe use during pregnancy and lactation has not been established. Actidose with Sorbitol and Actidose-Aqua should be used during pregnancy or lactation only if the potential benefit justifies the potential risk. No ter-atogenic effects have been noted in rabbits or rats. Last reviewed on RxList: 11/6/2008
This monograph has been modified to include the generic and brand name in many instances.

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No information provided.

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Actidose-Aqua Bottles     25 Gram/120 ml NDC 0574-0121-04 50 Gram/240 ml NDC 0574-0121-08 Actidose with Sorbitol 25 Gram/120 ml NDC 0574-0120-04 50 Gram/240 ml NDC 0574-0120-08 Actidose-Aqua Tubes     15 Gram/72 ml NDC 0574-0121-25 25 Gram/120 ml NDC 0574-0121-74 50 Gram/240 ml NDC 0574-0121-76 Actidose with Sorbitol 25 Gram/120 ml NDC 0574-0120-74 50 Gram/240 ml NDC 0574-0120-76 REFERENCES 1. Activated Charcoal, Antidotal and Other Medicinal Uses, Marcel Dekker, New York, 1980. 2. Clinical Pharmacokinetics. 1982; 7: 465-489 9. Ann. Emerg. Med. 1985; 14: 1152-1155 13. Lancet. 1981; 2: 1177-1178 14. NEJM. 1982; 307: 676-678 15. NEJM. 1982; 307: 642-644 16. Clin. Pharmacol. Therap. 1983; 34: 663-666 21. Ann Emerg Med. 1988; 17: 595-598 22. Ann Emerg Med. 1990; 19: 453 23. Ann Emerg Med. 1987; 16: 164-166 24. Ann Emerg Med. 1991; 20: 529-531 25. J. Pediatrics. 1986; 109: 719-722 Rev (09-98). Manufacturer: n/a. FDA rev date: n/a Last reviewed on RxList: 11/6/2008
This monograph has been modified to include the generic and brand name in many instances.

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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 adjuncts in the management of poisoning emergencies. Prior to the use of activated charcoal, proper basic life support measures must be implemented as well as the appropriate gastric emptying technique if indicated. When Actidose with Sorbitol or Actidose-Aqua are used to treat a poisoning emergency, the patient and health care providers should be aware that activated charcoal will produce black stools. These stools may be diarrhetic and may persist for several hours. Actidose with Sorbitol may produce a profound cathartic effect and proper attention should be given to the patient's fluid and electrolyte needs. Actidose with Sorbitol should be used cautiously in patients receiving multiple dose activated charcoal. If Actidose with Sorbitol is used at each dosage interval, profound catharsis may develop which could result in dehydration, hypotension and significant electrolyte and fluid abnormalities. A study conducted in healthy adult human volunteers who ingested therapeutic amounts of activated charcoal and sorbitol resulted in severe prolonged diarrhea, but no significant changes were noted in serum electrolytes or osmolality, BUN, or the metabolic profile as compared to the control.8 Gastrointestinal obstruction from activated charcoal may occur as a consequence of toxin-induced antiperistaltic effects. Actidose with Sorbitol and Actidose-Aqua should be used cautiously in patients who have been exposed to toxins which interfere with gastrointestinal tract peristalsis (i.e., anticholinergics, opioids, etc.). Bowel sounds should be frequently monitored to assess peristaltic action, especially in patients undergoing multiple dose activated charcoal therapy. REFERENCES 8. Clinical Toxicology. 1985; 22: 529-536Last reviewed on RxList: 11/6/2008
This monograph has been modified to include the generic and brand name in many instances.

Source: http://www.rxlist.com

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