Dosing and uses of Radiogardase, ferric hexacyanoferrate (Prussian blue)
Adult dosage forms and strengths
capsule
- 500mg
Cesium or Thallium Contamination
Indicated for treatment of patients with known or suspected internal contamination with radioactive cesium and/or radioactive or nonradioactive thallium to increase their rates of elimination
3 g PO q8hr; 30 day treatment minimum
Administration
Initiate as soon as contaminated is suspected or as soon as drug becomes available; monitor radioactivity levels before, during and after treatment to determine treatment duration
Pediatric dosage forms and strengths
capsule
- 500mg
Cesium or Thallium Contamination
Indicated for treatment of patients with known or suspected internal contamination with radioactive cesium and/or radioactive or nonradioactive thallium to increase their rates of elimination
<2 years: Safety and efficacy not established
2-12 years: 1 g PO q8hr; minimum 30 days treatment
>12 years: As adult; 3 g PO q8hr; 30 day treatment minimum
Administration
Initiate as soon as contaminated is suspected or as soon as drug becomes available; monitor radioactivity levels before, during and after treatment to determine treatment duration
Patients unable to swallow may be given capsules opened and mixed with bland food or liquids; may cause blue discoloration of mouth and teeth
Renal Impairment
Not studied
Hepatic Impairment
Effectiveness may decrease due to failure to excrete cesium and thallium
Radiogardase, ferric hexacyanoferrate (Prussian blue) adverse (side) effects
>10%
Constipation (24%)
1-10%
Asymptomatic hypokalemia (7%)
Warnings
Contraindications
None
Cautions
Monitor for decreased gastrointestinal motility if radiation absorbed dose to gastrointestinal mucosa increased
Monitor and treat constipation
Monitor for serum electrolyte abnormalities during treatment
Blue discoloration of stool, oral mucosa, and dentition may occur
Pregnancy and lactation
Pregnancy category: C (risk of toxicity from untreated radioactivity likely higher than risk from Radiogardase)
Lactation: unknown; unlikely to be excreted in breast milk (women internally contaminated with radioactivity should not breastfeed anyway)
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Radiogardase, ferric hexacyanoferrate (Prussian blue)
Mechanism of action
Reduces gastrointestinal reabsorption by binding to cesium & thallium isotopes in the GI tract after ingestion or excretion in bile
Pharmacokinetics
Bioavailability: Not systemically bioavailable
Excretion: Feces (99% unchanged)
