Prussian Blue, Insoluble (Radiogardase®)

• Indications and Usage
• Reference Links
• Prussian Blue information sheet for the general public (HHS/CDC)
• How to Get?

Indications and Usage

• This oral ion-exchange drug is indicated for decorporation of cesium and thallium and has been shown to be highly effective for Cs-137 contamination.
• Prussian blue is not FDA approved for rubidium.
• It is benign, with the exception of occasional constipation.
• Prussian blue turns the stool color blue.
• Marketed as 0.5 gram (500 mg) insoluble Prussian blue in gelatin capsules for oral administration.
• Prussian blue is available only by prescription.
• PO Dosing
  • Adults (Two adult recommended dosing regimens exist.)
    • From Goiânia accident data (PDF - 6.4 MB):
      • 1-3 grams (2-6 capsules) PO tid
      • Usual dose starts at 1 g (2 capsules) PO tid for up to 3 weeks (or longer, as required).
      • Doses up to 10-12 g/day for more significantly contaminated adults may be used
    • FDA drug label (PDF - 208 KB): 3 g (6 capsules) PO tid
  • Children 2-12 years old
    • FDA drug label (PDF - 208 KB): 1 g (2 capsules) PO tid. Capsules may be opened and mixed with food.
  • Children <2 years old
    • CAUTION: Use has not been approved by the FDA. However, during a mass casualty emergency, medical leaders may activate an EUA for how to use Prussian Blue from the SNS in children under 2 years of age.
  • Duration of treatment
    • Typically, a minimum of a 30 day course has been recommended, but clinical and availability conditions may alter this recommendation.
    • It is useful to obtain bioassay and whole body counting to assess treatment efficacy.
    • Duration of therapy depends on total body burden and response to treatment.
  • The HHS/ASPR, which manages the SNS, has included Prussian blue in the Strategic National Stockpile (SNS), a special collection of drugs and medical supplies that HHS/ASPR keeps to treat people in an emergency.
  • Other names for Prussian blue:
    • Berlin blue
    • Ferric ferrocyanide
    • Ferric(III) hexacyanoferrate
    • Ferric hexacyanoferrate (II)
    • Iron blue
    • Radiogardase-Cs
    • Fe4[Fe(Cn6)]3

  top of page

  ---

  
  

  Reference Links

  
  

  CDC resources

  • Facts about Prussian Blue
  • Prussian Blue Fact Sheet (PDF - 79 KB)
  • Prussian Blue: Introductory Information (YouTube: 2:48 minutes)

  FDA resources

  • Drug label for Prussian blue (Radiogardase) (PDF - 207 KB)
  • Prussian Blue: Approved Dosing for Children (PDF - 207 KB) (page 7)
  • FDA Approves First New Drug Application for Treatment of Radiation Contamination due to Cesium or Thallium (2003)

  Other

  • Prussian Blue (Radiogardase) (YouTube: 2:20 minutes) (DOE/ORISE/REAC/TS)
  • Use of Prussian Blue (Ferric Hexacyanoferrate) for Decorporation of Radiocesium (Public Health England [PHE], formerly Health Protection Agency [HPA], December 2010)
  • Rump A, Stricklin D, Lamkowski A, Eder S, Port M. Benefit-Cost Analysis of Radiocesium Decorporation by a Prussian Blue Treatment and Stockpiling. Drug Res (Stuttg). 2018 Feb;68(2):89-99. [PubMed Citation]

  top of page

  ---

  
  

  How to Get?

  
  
  • Prussian blue is available only by prescription.
  • Strategic National Stockpile
  • How to get prussian blue in US
    • See information provided by REAC/TS

  top of page

  ---

  
  

  References

  1. Dose assessment of inhaled radionuclides in emergency situations (Public Health England [PHE], formerly Health Protection Agency [HPA]/United Kingdom and Treatment Initiatives After Radiological Accidents (TIARA) Project/European Commission, August 2007)
  2. Management of Persons Contaminated With Radionuclides: Handbook (NCRP Report No. 161, Vol. I), National Council on Radiation Protection and Measurements, Bethesda, MD, 2008, Decorporation Therapy by Drug (pp. 201-209). [Note: NCRP 161 supersedes NCRP 65.]
  3. Management of Persons Contaminated with Radionuclides: Scientific and Technical Bases (NCRP Report No. 161, Vol. II), National Council on Radiation Protection and Measurements, Bethesda, MD, 2010, Appendix H.3 Goiânia Incident (pp. 908-915).
  4. Uncertainties in Internal Radiation Dose Assessment (NCRP Report No. 164), National Council on Radiation Protection and Measurements, Bethesda, MD, 2009.
  5. Cesium-137 in the Environment: Radioecology and Approaches to Assessment and Management, (NCRP Report No. 154), National Council on Radiation Protection and Measurements, Bethesda, MD, 2006.