Details About Overdose or Poisoning Generic Salt ::  Prussian Blue

Prussian Blue

    

Drug Pharmacology ::

I. Pharmacology. InsolublePrussian blue (ferric hexacyanoferrate) has been used to treatradioactive and nonradioactive cesium and thallium poisonings. Owing tothe long half-lives of these isotopes, ingestion can pose significantlong-term health risks. Insoluble Prussian blue binds thallium and cesiumin the gut as they undergo enterohepatic recirculation, enhancing fecalexcretion. Proposed mechanisms of binding include chemical cationexchange, physical adsorption, and mechanical trapping within thecrystal lattice structure. Insoluble Prussian blue is not absorbedacross the intact GI wall.

Drug Indications ::

Indications. Known or suspected internal contamination by:

   

Radioactive cesium (eg, 137Cs) and nonradioactive cesium.

Radioactive thallium (eg, 201Tl) and nonradioactive thallium.

Drug Contra-Indications ::

III. Contraindications. Thereare no absolute contraindications. The efficacy of the agent relies ona functioning GI tract; thus, ileus may preclude its use andeffectiveness.

Drug Adverse Effects ::

IV. Adverse effects

   

Upset stomach and constipation.

May bind other elements, causing electrolyte or nutritional deficits, such as asymptomatic hypokalemia.

Does not treat the complications of radiation exposure.

Blue discoloration of feces (and teeth if capsules are opened).

E. Use in pregnancy.FDA category C (indeterminate) (see Table III–1). Since Prussian blueis not absorbed from the GI tract, effects on the fetus are notexpected.

Drug Lab Interactions ::

Drug or laboratory interactions

   

No major interactions.

May decrease absorption of tetracycline.

Drug Dose Management ::

Dosage and method of administration.

   

Adults and adolescents: Usual dose is 3 g orally TID (9 g daily),although higher doses (> 10 g daily) are often used for acutethallium poisoning (particularly if thallium is present in the GItract). Doses may be decreased to 1 to 2 g TID when internalradioactivity is reduced and to improve patient tolerance.

Pediatrics (2–12 years): 1 g orally TID.

Capsules may be opened and mixed with food or water for those who havedifficulty swallowing. However, this may cause blue discoloration ofthe mouth and teeth.

Co-ingestion with food may increase effectiveness by stimulating bile secretion.

E.Treatment should continue for a minimum of 30 days. The duration oftreatment should be guided by the level of contamination as measured bythe amount of residual whole-body radioactivity.

Drug Chemical Formulations ::

Formulations

   

Oral:Insoluble Prussian blue powder (Radiogardase™), 0.5 g in gelatincapsules, packaged in an amber bottle of 30 capsules each.

The suggested minimum stocking level totreat a 70-kg adult for the first month is 540 capsules (18 bottles, 30capsules each) based on a daily dose of 9 G. At this time, the minimumorder is 25 bottles. Prussian blue is kept in the Strategic NationalStockpile (SNS) at the CDC. The Radiation Emergency Assistance Center(REAC/TS), can be contacted for information on obtaining Prussian blueand its recommended dosing ([865] 576-3131, on the Internet atwww.orau.gov/reacts).

Disclaimer ::

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