Prussian Blue for Treatment of Radiocesium Poisoning

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

Disclosures

Pharmacotherapy. 2001;21(11) 

In This Article

Efficacy of Prussian Blue in Radiocesium Poisoning

The Goiania tragedy represented an opportunity to study the effects of Prussian blue in enhancing excretion of radiocesium in humans. As with many clinical toxicology studies, time elapsed since initial exposure, total time of exposure, and route of exposure to the radiocesium were not always known. Data were not always complete regarding compliance with and duration of Prussian blue therapy. Despite these limitations, this was the first large human trial in which data could be systematically collected regarding Prussian blue therapy for reducing radiocesium body burdens.

Table 1 provides data compiled about the agent for radiocesium poisoning in humans. Of the 88 cases listed, 80 (91%) represent patients from the Goiania tragedy. Overall, Prussian blue therapy reduced the biologic half-life of cesium by approximately 43%, which is slightly higher than the 33% widely reported in the literature. Unfortunately, the largest series of cases from the Goiania exposure[14] did not report quantitative data on cesium half-life before Prussian blue was administered. The study did report favorable clinical responses, and cesium half-life during the therapy was consistent with a reduction in physiologic half-life.[24]

The minimum effective dosage of Prussian blue appears to be 3 g/day, although larger dosages, up to 10 g/day, were well tolerated. Evidence that larger dosages are more effective is inconsistent. One study[24] reported that reduction in cesium half-life was independent of Prussian blue dosage; data from another study[10] hinted at a dose-response relationship. As previously discussed, it is important to monitor potassium levels and maintain adequate bowel motility during the therapy. Duration of therapy is determined by total body burden of radiocesium, continued enhancement of radiocesium excretion, and long-term tolerability of Prussian blue. In one study[10] a small number of children (aged 3-19 years) appeared to respond to 3 g/day of Prussian blue, although their reduction in cesium half-life was, in some cases, less dramatic than that of the adult population.

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