Activated charcoal palatability study: do additives improve taste, ease of swallowing, and tolerability?

Activated charcoal is the most widely used gastrointestinal decontaminant in poisoning. Its clinical benefit relies on patients ingesting an adequate dose, yet poor palatability often limits compliance. Enhancing taste and ease of swallowing may improve adherence. This study examines whether mixing activated charcoal with chocolate milk, apple juice, or ice cream improves palatability and willingness to consume a full therapeutic dose.

A single-centre, crossover study involved 60 healthy adults tasting activated charcoal mixed in a 4:1 charcoal-to-additive ratio with water, chocolate milk, apple juice, or ice cream, in random order, with a 15-min washout period. After each tasting, participants rated taste and ease of swallowing on a 10-point visual analogue scale and indicated willingness to consume a full 50-gram dose (250 mL). Data were analysed using repeated-measures ANOVA, Cochran's Q, and regression models.

Sixty volunteers participated, 29 (48.3%) male, median age 22 years (IQR: 21-23 years, range: 18-44 years). Chocolate milk had the highest mean rating 5.57 (SD: 2.28) (P <0.05). For ease of swallowing, ice cream had the lowest mean rating 3.55 (SD: 2.08) (P <0.05). Full-dose acceptance was highest with chocolate milk (58%) and lowest with ice cream (35%), with a significant difference between them (P = 0.03). Taste was a significant predictor of full-dose willingness for chocolate milk (OR = 1.81, P = 0.02). Women were more likely than men to accept a full dose with chocolate milk (OR = 3.92, P = 0.04).

Our findings align with previous studies showing that additives improve activated charcoal palatability, with chocolate milk preferred over apple juice, ice cream, and water. Importantly, we assessed willingness to consume a full dose, a novel and clinically relevant measure of adherence and chocolate milk showed the highest willingness.

In this volunteer study, chocolate milk significantly improved charcoal acceptance. Taste influenced full-dose willingness across additives, suggesting a role in optimising activated charcoal administration.