Prussian blue (medical use)

Prussian blue, also known as potassium ferric hexacyanoferrate, is used as a medication to treat thallium poisoning or radioactive cesium 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]

Prussian blue
Prussian blue
Clinical data
Trade namesRadiogardase, others
AHFS/Drugs.comMonograph
Pregnancy
category
  • US: C (Risk not ruled out)
    Routes of
    administration    		by mouth
    ATC code
    Identifiers
    CAS Number
    PubChem CID
    ChemSpider
    UNII
    Chemical and physical data
    Molar mass859.24

    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 works by binding to and thus preventing the absorption of thallium and cesium 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, it is only approved for medical use in Germany, the United States, and Japan.[8][9][10] In the United States a course of treatment costs more than $200.[2] 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 cesium poisoning.[1][2][12] It may also be used for exposure to radioactive material until the underlying type is determined.[3]

    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]

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    References
    1. 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.
    2. Hamilton, Richart (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 472. ISBN 9781284057560.
    3. "Prussian Blue". The American Society of Health-System Pharmacists. Archived from the original on 18 January 2017. Retrieved 8 January 2017.
    4. Dart, Richard C. (2004). Medical Toxicology. Lippincott Williams & Wilkins. p. 248,279. ISBN 9780781728454. Archived from the original on 2017-01-16.
    5. "Glucose-6-phosphate dehyrogenase deficiency — Medlibes: Online Medical Library". medlibes.com. Archived from the original on 2016-09-15. Retrieved 2017-05-03.
    6. Hall, Alan H.; Isom, Gary E.; Rockwood, Gary A. (2015). 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.
    7. 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.
    8. Goyer, Robert A. (2016). Metal Toxicology: Approaches and Methods. Elsevier. p. 93. ISBN 9781483288567.
    9. Dobbs, Michael R. (2009). Clinical Neurotoxicology: Syndromes, Substances, Environments. Elsevier Health Sciences. p. 280. ISBN 0323052606.
    10. "Radioaktivität: Berliner Blau als Arzneimittel". Dtsch Arztebl (in German). 1 July 2011.
    11. Archiver, Truthout (27 June 2011). "Fukushima's Cesium Spew - Deadly Catch-22s in Japan Disaster Relief". Truthout. Archived from the original on 16 January 2017. Retrieved 15 January 2017.
    12. "Questions and Answers on Calcium-DTPA and Zinc-DTPA (Updated)". U.S. Food & Drug Administration. Retrieved 21 March 2020.
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