Prussian Blue, Insoluble (Radiogardase®)

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. (IND or EUA may be required)
  • 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 CDC has included Prussian blue in the Strategic National Stockpile (SNS), a special collection of drugs and medical supplies that CDC 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

FDA resources


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  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. 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