Prussian Blue (Oral)

Prussian blue is used to treat thallium and radiocesium poisoning by combining the two in the intestines and stops them from being re-absorbed into the body.

Overview

Prussian blue treats patients with thallium or radiocesium poisoning by binding the two isotopes in the gastrointestinal tract and the combination removes the poison from the body through the patient's stools. With the removal of thallium or radiocesium through the stool, the harm to the patient's tissues and organs remain reduced with this medication. Administered orally to stimulate the excretion of cesium or thallium, this medication is only available by prescription through a doctor.

Cesium is a natural metal element while Cesium-137 is a radioactive form used in an assortment of devices as a source to treat particular cancers. Thallium, found in many minerals, becomes extremely toxic when used with various compounds. The production of Prussian blue results from the oxidization of ferrous ferrocyanide salts.

Prussian blue is a dark blue pigment initially developed for use as a dye in ink and paints; and as a medicine, it helps to speed up the body's elimination of metal or chemical elements. The patient should be aware that there is a difference between a Prussian blue artist dye and the Prussian blue capsules used for radiation treatment; therefore, no attempt should take place to administer the painter's dye as a replacement for the Prussian blue medication.

Prussian blue succeeds greatest when taken with food and administered three times per day for at least 30 days or as intended. If a patient is unable to swallow a large number of capsules at a time during this treatment, mix the contents of the open capsules with liquid or plain food.

The patient will be subject to continuous laboratory exams to see the course of progress while on this medication. This will determine if the patient stays on the product for a longer or shorter period based on health and lab results.

Although Prussian blue aids the body to eradicate radioactive elements quickly, it does not treat the actual signs of exposure to radiation. Your healthcare professional will need to give you other medications to treat any difficulties that occur as a result of radiation exposure.

Conditions Treated

  • Radioactive cesium or thallium
  • Non-radioactive thallium

Type of Medicine

  • Brand name: Radiogardase, Antidotum Thallii-Heyl
  • Generic name: Prussian blue
  • Other names: Paris blue, Prussian blue insoluble, Berlin blue, Ferric ferrocyanide, Ferric hexacyanoferrate ll / lll, Iron blue, Ferrocin, Fe4 [Fe (Cn6)] 3, Parisian blue

Side Effects

Some side effects may not need medical attention as they may disappear during the course of the treatment as the patient's body adjusts to the medication. Ordinarily, this medication may create dark or blue stools which do not require the need for medical assistance. Always check with your physician if certain side effects continue on a regular basis or you may contact the FDA if an unusual reaction occurs.

More common:

  • Decreased urine
  • Muscle cramps
  • Dry mouth
  • Tiredness or weakness
  • Numbness in extremities
  • Convulsions
  • Loss of appetite
  • Change in mood
  • Bowel movement difficulties
  • Increase in thirst
  • Heartbeat irregularities
  • Vomiting
  • Breathing difficulties

Common:

Less common:

  • Blue stools

Dosage

The medication dosage will depend on the patient based on their physician's orders or according to manufacturer's directions. The following is an average dose and your medication may differ from this format. Always check with your doctor before making any changes in dosage unless instructed otherwise.

Although this medication is in capsule form, if the patient is unable to swallow the capsule, it may be mixed with water and drunk right away. Any of the medicine residue left in the glass must be consumed immediately; therefore, additional amounts of water may be added in order for the patient to complete this action.

Your physician might prescribe supplementary medication in order to prevent constipation while you are taking this medication. Should you miss a dose, take the next scheduled dose as soon as you are able and do not try to take any additional medication. In the advent of an overdose, seek medical help as soon as possible or contact the Poison Helpline on 1-800-222-1222. In Canada, contact the local poison control center.

For radiocesium poisoning:

  • Adults and children: 500mg every two hours, totaling 3000mg (three grams) a day. This dosage, as determined by your physician, may last for several days or possibly three weeks.
  • Children under the age of two must follow a dosage as determined by their healthcare professional.

For thallium poisoning:

  • Adults and teenagers: three grams or 6 capsules, three times a day.
  • Children 12 years old and under: one gram, or 2 capsules, three times a day.
  • Children under the age of two must follow a dosage as instructed by their healthcare professional.

For chronic thallium poisoning:

  • Adults and children: three to 20 grams per day divided into smaller portions as directed by your physician. The healthcare professional may direct the patient to divide the dosage into four lesser doses, based on body weight, and taken for two to three weeks.

In the event of radiation emergency:

  • Product should be taken immediately with food to increase excretion of stool
  • Treatment may last longer than 30 days
  • Weekly laboratory exams needed to measure radiation levels in urine and stool
  • Continuation of treatment within a time frame that shows an acceptable level of radiation

In order to accelerate the excretion of thallium or cesium, the capsule should be taken with food. A laxative or high fiber diet included in this treatment helps to increase regular elimination. The duration of the therapy will depend on the response of the total body reaction.

Interactions

Your healthcare professional must remain up to date with regard to any additional medication the patient takes in the event that a negative interaction may occur. There are no direct major drug interactions with this product, but any over-the-counter medication that is being used by the patient, should, nevertheless, become a part of the detailed information given to their healthcare practitioner.

Warnings

Be sure to inform your physician if you have other medical problems that may affect the use of this medicine. The importance of regular doctor visits for you or your child will help to keep an eye on the progress of the medication and determine if this course of treatment should continue. Laboratory exams including urine and blood will be necessary during this healing process to test for unwelcome effects.

This medication may cause low potassium in the blood and reduce gastrointestinal ability leaving the patient in the situation of increased radiation absorbed into their stomach. The patient should contact their physician immediately should constipation occur or muscle cramps, nausea or increased thirst takes place.

The patient's stools may appear blue in color which is normal and should not be a concern for worry. In the event the capsule contents mix with food, the patient's teeth and mouth might turn blue as well.

It is unknown as to whether or not Prussian blue affects pregnant women or passes into breast milk, but caution should be considered if the patient is using this medication while breastfeeding or if an internal contamination already exists. In men, exposure to radiation may cause a low sperm count and discussions should take place with their physician with any concerns about fertility and the possibility of any long-term harmful effects.

Sufficient evidence has not been recognized as to the safety of using Prussian blue in children under the age of two. There are no further data that states that this medication may be more harmful to someone older as opposed to their younger counterpart, but observation of patients over the age of 65 due to the possibility of reduced heart-related function or other recurring illness remains a consideration.

Other medical problems:

  • Arrhythmia
  • Intestinal blockage
  • Constipation or other stomach disorders
  • Electrolyte imbalance
  • Liver disease
  • Bowel problems

Storage

Store this medication in a dark, closed container at room temperature, 20 degrees to 25 degrees C (68 degrees to 77 degrees F), away from moisture, direct light and heat; never frozen. As with all medications, keep out of the reach of pets and children.

Consult your physician as to the correct way to dispose of any expired or unused product.

Summary

Prussian blue confines radioactive cesium and thallium in the intestines and as the poisons move through the intestines, excretion takes place through the bowel movements. This medication reduces the time that the radioactive substance stays in the body and limits the time the body has contact with radiation.

Once the patient has started to take Prussian blue, their stools and urine will include radioactive materials as a result and consequently, a recommendation for the patient to wash their hands thoroughly as well as use protective clothing helps to avoid any further contamination.

With this medication, it is important to note that the capsules should be taken immediately as directed by a healthcare professional, once it is known that the patient has been diagnosed with exposure to internal radiation. The time frame for taking this product may last up to 30 days depending on the patient's health and the progress the patient makes. Your healthcare professional or a health department official can tell you the best options for dealing with radioactive matter and their disposal during your treatment.

Moreover, as with any medication, the patient should always discuss the treatment they are about to receive from their physician regarding the benefits and how this medication may affect their lifestyle, including dietary changes.

Accordingly, regular visits to the doctor while using this product will ensure the patient's progress is taking place as planned. Inform your physician of any negative reactions as a result of using this product as well as any other medications that are pertinent to your therapy.

 

Resources
Last Reviewed:
February 01, 2018
Last Updated:
April 05, 2018
Content Source: