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Prussian Blue

Pronouncation: (PRUSH-en)
Class: Chelating agent

Trade Names:
Radiogardase
- Capsules 0.5 g

Pharmacology

Prussian blue insoluble binds radioactive and non-radioactive cesium and thallium in the GI tract by ion-exchange, adsorption, and mechanical trapping within the crystal structure.

Pharmacokinetics

Absorption

Not absorbed through intact GI wall.

Elimination

99% excreted unchanged in feces.

Special Populations

Hepatic Function Impairment

May be less effective because of decreased biliary excretion of cesium and thallium.

Indications and Usage

Treatment of patients with known or suspected internal contamination with radioactive cesium and/or radioactive or non-radioactive thallium to increase the rate of their elimination.

Contraindications

None known.

Dosage and Administration

Radioactive cesium (137Cs) contamination
Adults

PO 3 g 3 times daily for minimum of 30 days; when internal radioactivity is substantially reduced, dose may be reduced to 1 to 2 g 3 times daily.

Children 2 to 12 yr of age

PO 1 g 3 times daily.

Thallium contamination (radioactive and nonradioactive)
Adults

PO 3 g 3 times daily.

Children 2 to 12 yr of age

PO 1 g 3 times daily.

General Advice

Administer with food to stimulate biliary excretion of cesium or thallium.
For patients who cannot tolerate swallowing large numbers of capsules, the capsules may be opened and contents mixed with bland food or liquids. Blue discoloration of mouth and teeth may occur.

Storage/Stability

Store in the dark at controlled room temperature (59° to 86°F).

Drug Interactions

None well documented. However, there are anecdotal reports of decreased tetracycline bioavailability.

Laboratory Test Interactions

None well documented.

Adverse Reactions

GI

Constipation (24%); hypokalemia (7%); undefined gastric distress.

Precautions

Monitor

Monitor CBC, serum chemistry, and electrolytes weekly during treatment with Prussian blue insoluble. As appropriate, monitor blood levels and/or clinical response to oral medications whose absorption could be altered by Prussian blue insoluble. Measure and record Cesium-137 radioactivity counts in urine and fecal samples to monitor elimination rate.

Pregnancy

Category C .

Lactation

Undetermined. Women contaminated with cesium or thallium should not breast-feed.

Children

Dosing in infants and neonates (0 to 2 yr of age) has not been established.

Cardiac arrhythmias

Use caution when treating patients with preexisting cardiac arrhythmias.

Complications of radiation exposure

Prussian blue insoluble reduces radiation exposure but does not treat complications of radiation exposure. Supportive treatment for radiation toxicity symptoms should be given concomitantly.

Constipation

Can cause constipation. Treat constipation with fiber-based laxative and/or high-fiber diet.

Decreased GI motility

Use with caution.

Electrolyte imbalances

Use caution when treating patients with preexisting electrolyte imbalances.

Radiation exposure

Cesium-137 is excreted in the urine and feces. Apply appropriate safety measures to minimize radiation exposure to others: take precautions handling urine or feces; use toilet instead of urinal, and flush several times after each use; completely clean up spilled urine or feces; wash contaminated clothing separately.

Unknown/multiple radioactive element exposure

May require treatment with other agents in addition to Prussian blue insoluble.

Patient treatment data

Complete Prussian Blue Patient Treatment Data Form and forward to manufacturer following treatment.

Overdosage

Symptoms

Possible symptoms include obstipation, obstruction, or severe decrease in electrolytes.

Patient Information

Advise patient to take each dose with meals to increase effectiveness.
Caution patient not to change the dose or stop taking unless advised by health care provider.
Advise patients who cannot tolerate swallowing large numbers of capsules that the capsules may be opened and the powder contents mixed with bland food or liquids and then swallowed. Caution patient that this may lead to a bluish discoloration of the mouth and teeth.
Advise patient to ingest a high-fiber diet and/or fiber-based laxative to prevent constipation, and to report bothersome constipation to health care provider.
Advise patient or caregiver that medication may cause stools to have a blue-color, but this is expected and of no concern.
Review the following safety precautions to reduce radiation exposure to Cesium-137: take extra precautions in handling urine or feces and wash hands thoroughly after contact; flush toilet several times after use; clean up spilled urine or feces completely; wash contaminated clothing separately.