Prussian blue (medical use) explained

Drug Name:Prussian blue
Tradename:Radiogardase, others
Pregnancy Us:C
Routes Of Administration:by mouth
Cas Number:25869-98-1
Atc Prefix:V03
Atc Suffix:AB31
Pubchem:2724251
Chemspiderid:146359
Unii:K2CJI135MU
Chemical Formula:C18Fe7N18
Molecular Weight:859.24

Prussian blue, also known as potassium ferric hexacyanoferrate, is used as a medication to treat thallium poisoning or radioactive caesium poisoning.[1] For thallium it may be used in addition to gastric lavage, activated charcoal, forced diuresis, and hemodialysis. It is given by mouth or nasogastric tube.[2] Prussian blue is also used in the urine to test for G6PD deficiency.[3]

Side effects may include constipation, low blood potassium, and stools that are dark.[1] With long-term use, sweat may turn blue. It mainly works by trapping the toxic monovalent cations in its crystal lattice after ion-exchange with potassium or ammonium cations and thus preventing the absorption of thallium and radio-caesium from the intestines.[4]

Prussian blue was developed around 1706.[5] It is on the World Health Organization's List of Essential Medicines.[6], it is only approved for medical use in Germany, the United States, and Japan.[7] [8] [9] Access to medical-grade Prussian blue can be difficult in many areas of the world including the developed world.[10]

Medical uses

Prussian blue is used to treat thallium poisoning or radioactive caesium poisoning.[1] [11] [12] It may also be used for exposure to radioactive material until the underlying type is determined.[4]

Often it is given with mannitol or sorbitol to increase the speed it moves through the intestines.[2]

Prussian blue is also used to detect hemosiderin in urine to confirm a diagnosis of G6PD deficiency.[3]

Thallium poisoning

For thallium it may be used in addition to gastric lavage, forced diuresis, and hemodialysis.[4]

It is given until the amount of thallium in the urine drops to below 0.5 mg per day.[2]

Caesium poisoning

It is specifically only used for radioactive caesium poisoning when the caesium has entered the body either by swallowing or breathing it in.[2]

Notes and References

  1. Book: WHO Model Formulary 2008 . 2009 . 9789241547659 . ((World Health Organization)) . Stuart MC, Kouimtzi M, Hill SR . 10665/44053 . World Health Organization . World Health Organization . free . 65 .
  2. Book: Seifert SA . Elimination Enhancement . Dart RC . Medical Toxicology. 2004. Lippincott Williams & Wilkins. 9780781728454. 248,279. https://books.google.com/books?id=BfdighlyGiwC&pg=PA270. en. live. https://web.archive.org/web/20170116174329/https://books.google.ca/books?id=BfdighlyGiwC&pg=PA270. 2017-01-16.
  3. Web site: Glucose-6-phosphate dehyrogenase deficiency . Medlibes: Online Medical Library. 28 July 2010 . 2017-05-03. live. https://web.archive.org/web/20160915060308/http://medlibes.com/entry/glucose-6-phosphate-dehyrogenase-deficiency. 2016-09-15.
  4. Web site: Prussian Blue. The American Society of Health-System Pharmacists. 8 January 2017. live. https://web.archive.org/web/20170118044341/https://www.drugs.com/monograph/prussian-blue.html. 18 January 2017.
  5. Book: Hall AH, Isom GE, Rockwood GA . Physicochemical Properties, synthesis, applications, and transport . Toxicology of Cyanides and Cyanogens: Experimental, Applied and Clinical Aspects. 2015. John Wiley & Sons. 9781118628942. 43. https://books.google.com/books?id=rF2-CgAAQBAJ&pg=PA43. en. live. https://web.archive.org/web/20170116174254/https://books.google.ca/books?id=rF2-CgAAQBAJ&pg=PA43. 2017-01-16.
  6. Book: ((World Health Organization)) . World Health Organization model list of essential medicines: 21st list 2019 . 2019 . 10665/325771 . World Health Organization . World Health Organization . Geneva . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO . free .
  7. Book: Angle CR . Organ-Specific Therapeutic Intervention . Goyer RA . Metal Toxicology: Approaches and Methods. 2016. Elsevier. 9781483288567. 93. https://books.google.com/books?id=DiElBQAAQBAJ&pg=PA93. en.
  8. Book: Rusyniak DE . Thallium . Dobbs MR . Clinical Neurotoxicology: Syndromes, Substances, Environments. 2009. Elsevier Health Sciences. 978-0323052603. 280. https://books.google.com/books?id=Pmcy24y2HyMC&pg=PA280. en.
  9. Ruprecht J . Radioaktivität: Berliner Blau als Arzneimittel . Radioactivity: Prussian Blue as a medicine . Deutsches Ärzteblatt . German Medical Journal . 1 July 2011 . de.
  10. News: Kubiak WD . 27 June 2011 . Truthout . Fukushima's Caesium Spew - Deadly Catch-22s in Japan Disaster Relief. https://web.archive.org/web/20190823234216/https://truthout.org/articles/fukushima-s-cesium-spew-deadly-catch-22s-in-japan-disaster-relief/ . 23 August 2019 .
  11. Book: Hamilton. Richart. Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. 2015. Jones & Bartlett Learning. 9781284057560. 472.
  12. Web site: Questions and Answers on Calcium-DTPA and Zinc-DTPA (Updated) . U.S. Food & Drug Administration . 3 November 2018 . 21 March 2020.

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