Prussian blue (medical use)

Prussian blue
	Prussian blue
Clinical data
Trade names	Radiogardase, others
AHFS/Drugs.com	Monograph
Routes of; administration	by mouth
ATC code	V03AB31 (WHO) ;
Identifiers
CAS Number	25869-98-1 ;
PubChem CID	2724251;
ChemSpider	146359;
UNII	K2CJI135MU;
Chemical and physical data
Formula	C18Fe7N18
Molar mass	859.24

Prussian blue, also known as potassium ferric hexacyanoferrate, is used as a medication to treat thallium poisoning or radioactive caesium poisoning.^[1]^[2] For thallium it may be used in addition to gastric lavage, activated charcoal, forced diuresis, and hemodialysis.^[3]^[4] It is given by mouth or nasogastric tube.^[2]^[4] Prussian blue is also used in the urine to test for G6PD deficiency.^[5]

Side effects may include constipation, low blood potassium, and stools that are dark.^[1]^[3] With long-term use, sweat may turn blue.^[3] 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.^[3]

Prussian blue was developed around 1706.^[6] It is on the World Health Organization's List of Essential Medicines.^[7] As of 2016^[update], it is only approved for medical use in Germany, the United States, and Japan.^[8]^[9]^[10] Access to medical-grade Prussian blue can be difficult in many areas of the world including the developed world.^[11]

Medical uses

Prussian blue is used to treat thallium poisoning or radioactive caesium poisoning.^[1]^[2]^[12] It may also be used for exposure to radioactive material until the underlying type is determined.^[3]^{[clarification needed]}

Often it is given with mannitol or sorbitol to increase the speed it moves through the intestines.^[4]

Prussian blue is also used to detect hemosiderin in urine to confirm a diagnosis of G6PD deficiency.^[5]

Thallium poisoning

For thallium it may be used in addition to gastric lavage, forced diuresis, and hemodialysis.^[3]

It is given until the amount of thallium in the urine drops to below 0.5 mg per day.^[4]

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.^[4]

References

^ ^a ^b ^c World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 65. hdl:10665/44053. ISBN 9789241547659.
^ ^a ^b ^c Hamilton, Richart (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 472. ISBN 9781284057560.
^ ^a ^b ^c ^d ^e ^f "Prussian Blue". The American Society of Health-System Pharmacists. Archived from the original on 18 January 2017. Retrieved 8 January 2017.
^ ^a ^b ^c ^d ^e Seifert SA (2004). "Elimination Enhancement". In Dart RC (ed.). Medical Toxicology. Lippincott Williams & Wilkins. p. 248,279. ISBN 9780781728454. Archived from the original on 2017-01-16.
^ ^a ^b "Glucose-6-phosphate dehyrogenase deficiency". Medlibes: Online Medical Library. 28 July 2010. Archived from the original on 2016-09-15. Retrieved 2017-05-03.
^ Hall AH, Isom GE, Rockwood GA (2015). "Physicochemical Properties, synthesis, applications, and transport". Toxicology of Cyanides and Cyanogens: Experimental, Applied and Clinical Aspects. John Wiley & Sons. p. 43. ISBN 9781118628942. Archived from the original on 2017-01-16.
^ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
^ Angle CR (2016). "Organ-Specific Therapeutic Intervention". In Goyer RA (ed.). Metal Toxicology: Approaches and Methods. Elsevier. p. 93. ISBN 9781483288567.
^ Rusyniak DE (2009). "Thallium". In Dobbs MR (ed.). Clinical Neurotoxicology: Syndromes, Substances, Environments. Elsevier Health Sciences. p. 280. ISBN 978-0323052603.
^ Ruprecht J (1 July 2011). "Radioaktivität: Berliner Blau als Arzneimittel" [Radioactivity: Prussian Blue as a medicine]. Deutsches Ärzteblatt [German Medical Journal] (in German).
^ Kubiak WD (27 June 2011). "Fukushima's Caesium Spew - Deadly Catch-22s in Japan Disaster Relief". Truthout. Archived from the original on 23 August 2019.
^ "Questions and Answers on Calcium-DTPA and Zinc-DTPA (Updated)". U.S. Food & Drug Administration. 3 November 2018. Retrieved 21 March 2020.