Prussian Blue for Treatment of Radiocesium Poisoning

Dennis F. Thompson, Pharm.D., FASHP, FCCP, and Chelsea O. Church, Pharm.D.


Pharmacotherapy. 2001;21(11) 

In This Article

Abstract and Introduction

Prussian blue is a crystal lattice that exchanges potassium for cesium at the surface of the crystal. When given orally, it binds cesium that is secreted in the gut before it can be reabsorbed. Data suggest that in humans, Prussian blue can reduce cesium's half-life by approximately 43% and reduce total body burdens. Prussian blue is well tolerated at a dosage of 3 g/day with appropriate monitoring of serum potassium levels and observing for signs of constipation. Clinical data on the efficacy of Prussian blue in the management of radiocesium poisoning were evaluated. Articles published in English describing distribution and elimination of cesium in both humans and animals were reviewed, along with articles describing administration of Prussian blue in clinical toxicology.

On September 13, 1987, two men in Goiania, Brazil, were looking for scrap metal in a partially demolished medical clinic that had been abandoned 2 years earlier. While searching, they happened upon a radiation therapy machine housing 1400 curies of cesium-137 chloride. Not knowing what they had found, they sold the container to a junkyard dealer, who dismantled it. Within 2 weeks, local children had discovered the curious substance. Some painted themselves with the glowing blue powder; others slipped a lump of it into their pockets. Thus began a radiation disaster second in magnitude only to Chernobyl. A total of 244 individuals were exposed to the radiocesium; 104 showed evidence of internal contamination.[1,2,3,4] Although this event was a terrible radiation disaster, it provided an opportunity to systematically collect data on the efficacy of Prussian blue in treating radiocesium poisoning in humans.

To review the English-language literature regarding administration of Prussian blue in the management of radiocesium poisoning, we performed a MEDLINE search of literature published from 1966 to the present under various medical subject headings, including cesium poisoning and ferrocyanides. We also performed a fan search from bibliographies of selected papers and a manual search of Index Medicus back to 1957. We reviewed distribution and elimination of cesium in humans and factors affecting therapeutic administration of Prussian blue in radiocesium poisoning.