Soluble or Insoluble Prussian Blue for Radiocesium and Thallium Poisoning?

Department of Pharmacy Practice, College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK 73102-1080, USA.
Annals of Pharmacotherapy (Impact Factor: 2.06). 10/2004; 38(9):1509-14. DOI: 10.1345/aph.1E024
Source: PubMed


To review the available English-language literature concerning the efficacy of soluble and insoluble Prussian blue used as a therapeutic agent in radiocesium and thallium poisoning.
A thorough search of MEDLINE, Toxline, and EMBASE databases (1960s-August 2003) was performed. Search terms included Prussian blue, thallium, and radiocesium poisoning. Bibliographies of relevant papers were reviewed for additional citations. study selection AND DATA EXTRACTION: Reports and studies of human trials and cases, along with animal and relevant in vitro data, were sought. Data were categorized as insoluble and soluble Prussian blue and by thallium and radiocesium poisoning.
The majority of evidence describing the efficacy of Prussian blue for radiocesium poisoning is based on the use of the insoluble form. In contrast, the majority of data supporting the efficacy of Prussian blue in thallium poisoning involves the use of the soluble form.
Insoluble Prussian blue has recently been approved in the US for treatment of both thallium and radiocesium poisoning. While there is sufficient evidence that the insoluble form of Prussian blue is effective in radiocesium poisoning, there is a paucity of analogous data supporting its use in thallium poisoning. Whether the physicochemical differences between soluble and insoluble Prussian blue have any effect on outcomes in human poisoning is not known.

Download full-text


Available from: Dennis F Thompson, Mar 17, 2014
  • Source
    • "Prussian blue is a poorly absorbed complex of potassium hexacyanoferrate and is available in soluble (colloidal) and insoluble formulations [92]. Recently the insoluble formulation received approval from the US Food and Drug Administration as an antidote for cesium and thallium poisoning, although the soluble formulation may be more efficacious [79] [92]. The current manufacturer-recommended dose of Prussian blue is 3 g orally three times a day with others recommending 250 mg/kg given two times a day [93]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Humans have had a long and tumultuous relationship with heavy metals. Their ubiquitous nature and our reliance on them for manufacturing have resulted at times in exposures sufficient to cause systemic toxicity. Their easy acquisition and potent toxicity have also made them popular choices for criminal poisonings. This article examines the clinical manifestation and pathophysiology of poisoning from lead, mercury, arsenic, and thallium.
    Full-text · Article · Apr 2006 · Clinics in Laboratory Medicine
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The effects of chelating drugs used clinically as antidotes to metal toxicity are reviewed. Human exposure to a number of metals such as lead, cadmium, mercury, manganese, aluminum, iron, copper, thallium, arsenic, chromium, nickel and platinum may lead to toxic effects, which are different for each metal. Similarly the pharmacokinetic data, clinical use and adverse effects of most of the chelating drugs used in human metal poisoning are also different for each chelating drug. The chelating drugs with worldwide application are dimercaprol (BAL), succimer (meso-DMSA), unithiol (DMPS), D-penicillamine (DPA), N-acetyl-D-penicillamine (NAPA), calcium disodium ethylenediaminetetraacetate (CaNa(2)EDTA), calcium trisodium or zinc trisodium diethylenetriaminepentaacetate (CaNa(3)DTPA, ZnNa(3)DTPA), deferoxamine (DFO), deferiprone (L1), triethylenetetraamine (trientine), N-acetylcysteine (NAC), and Prussian blue (PB). Several new synthetic homologues and experimental chelating agents have been designed and tested in vivo for their metal binding effects. These include three groups of synthetic chelators, namely the polyaminopolycarboxylic acids (EDTA and DTPA), the derivatives of BAL (DMPS, DMSA and mono- and dialkylesters of DMSA) and the carbodithioates. Many factors have been shown to affect the efficacy of the chelation treatment in metal poisoning. Within this context it has been shown in experiments using young and adult animals that metal toxicity and chelation effects could be influenced by age. These findings may have a bearing in the design of new therapeutic chelation protocols for metal toxicity.
    Full-text · Article · Feb 2005 · Current Medicinal Chemistry
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although some antidotes are rarely used, they have an important, potentially life-saving role in the treatment of toxic exposures. The timely and judicious use of an antidote can prevent death and shorten hospitalization as well as reduce the patient's pain and suffering. Although their importance is recognized, sufficient stocking of antidotes remains a problem.
    Full-text · Article · Dec 2005 · Medical Clinics of North America
Show more