Prussian blue (medical use)

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]

Prussian blue
Prussian blue
Clinical data
Trade namesRadiogardase, others
AHFS/Drugs.comMonograph
Routes of
administration		by mouth
ATC code
Identifiers
CAS Number
  • 25869-98-1 Y
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 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, 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]

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
  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 978-0323052603.
  10. "Radioaktivität: Berliner Blau als Arzneimittel". Dtsch Arztebl (in German). 1 July 2011.
  11. Archiver, Truthout (27 June 2011). "Fukushima's Caesium 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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