Radiogardase

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

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    Reference Links

    CDC resources

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

    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) Watch video
    • 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]

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    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

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    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.