Ferric hexacyanoferrate, also known as Prussian blue, is a coordination compound with the chemical formula Fe4[Fe(CN)6]3. It is a dark blue pigment that has been used historically in painting, dyeing, and inks. In addition to its applications in the arts, Prussian blue has been employed in various other fields, including medicine and chemistry.

One of its notable uses is in the treatment of radioactive cesium poisoning. Due to its ability to effectively trap and eliminate cesium ions from the body, Prussian blue has been utilized as a medical intervention in cases of accidental ingestion or exposure to radioactive cesium isotopes.

In analytical chemistry, Prussian blue is also utilized as a reagent for the detection and quantification of certain metal ions. Its distinctive color change in the presence of specific ions makes it useful for qualitative and quantitative analysis.

Ferric hexacyanoferrate (Radiogardase) is used as an antidote that enhances the excretion of Cesium and Thallium from the body by binding to them in the gastrointestinal tract.

Ferric hexacyanoferrate (Radiogardase) Uses:

• Internal contamination:
  • It is indicated for the treatment of patients who have been contaminated or are suspected to have been contaminated with radioactive Cesium and radioactive or nonradioactive thallium.
  • The drug enhances the elimination of these agents.

Ferric hexacyanoferrate (Radiogardase) Dose in Adults

Ferric hexacyanoferrate (Radiogardase) Dose in the Internal contamination with radioactive cesium and/or radioactive or nonradioactive thallium: Oral:

Ferric hexacyanoferrate, also known as Prussian blue, is a medicine used to treat people who have been exposed to radioactive cesium or thallium. Here's how it's used:

• If someone has been exposed to cesium, they might need to take 1 to 3 grams of Prussian blue three times a day.
• It's best to start the treatment as soon as possible after exposure, but it can still work if treatment is delayed.
• Treatment usually lasts for at least 30 days.

Remember, the dosage might be different depending on the situation, so it's important to follow the doctor's instructions.

Ferric hexacyanoferrate (Radiogardase) Dose in Childrens

Ferric hexacyanoferrate (Radiogardase) Dose in Internal contamination with radioactive cesium and/or radioactive or nonradioactive thallium: Oral:

Ferric hexacyanoferrate, also known as Prussian blue, is used to treat people who have been exposed to radioactive cesium or thallium. Here's how it's used in different age groups:

• Children aged 2 to 12 years: They usually take 1 gram of Prussian blue three times a day.
• Adolescents (people aged 12 and older): They usually take the same dose as adults.

It's important to start treatment as soon as possible after exposure, but it can still work even if treatment is delayed. Treatment typically lasts for at least 30 days. Make sure to follow the doctor's instructions carefully.

Pregnancy Risk Factor C

• Ferric hexacyanoferrate, also known as Prussian blue, has been assigned a Pregnancy Risk Factor C.
• Animal studies regarding its effects on pregnancy haven't been conducted.
• However, because it's not absorbed by the body from the gut, it's not expected to harm the fetus.
• On the other hand, cesium-137 and thallium can pass through the placenta and potentially harm the developing baby, with reported cases of fetal death and growth problems.
• Despite this, the risk of toxicity from cesium or thallium exposure is considered higher than any risk from ferric hexacyanoferrate.
• Overall, when considering using antidotes like ferric hexacyanoferrate during pregnancy, doctors weigh the benefits against potential risks, ensuring the health of the mother remains a priority.
• They shouldn't avoid using antidotes due to concerns about harming the baby unless absolutely necessary.

Use during breastfeeding:

• The excretion of ferric hexacyanoferrate, or Prussian blue, in breast milk is not known, but it's not expected to happen.
• However, cesium and thallium, which are radioactive or toxic substances, can pass into breast milk.
• Therefore, mothers who are internally contaminated with cesium or thallium should not breastfeed their babies to prevent them from being exposed to these harmful substances.

Dose in Kidney Disease:

• The manufacturer's labeling does not specify any dosage adjustments for ferric hexacyanoferrate, also known as Prussian blue, because it is not absorbed into the body's system.
• This means that the amount of Prussian blue taken orally does not have an impact on the body's overall functioning since it remains in the gastrointestinal tract and is not absorbed into the bloodstream.
• Therefore, there is no need to adjust the dosage based on factors like age, weight, or medical conditions, as it primarily acts within the digestive system to bind with certain substances.

Dose in Liver disease:

• The manufacturer's labeling doesn't suggest any dosage adjustments for ferric hexacyanoferrate (Prussian blue).
• However, it's worth noting that its effectiveness might be reduced if there's a decrease in the biliary excretion of cesium and thallium.
• This means that if the body's ability to eliminate cesium and thallium through bile is impaired, Prussian blue might not work as effectively in trapping and removing these substances.

Side effects of Ferric hexacyanoferrate (Radiogardase):

• Gastrointestinal:
  • Constipation
  • Fecal discoloration (blue)
  • Fastric distress
• Endocrine & metabolic:
  • Hypokalemia

Contraindications to Ferric hexacyanoferrate (Radiogardase):

• The manufacturer's labeling does not list any contraindications for ferric hexacyanoferrate (Prussian blue).
• This means that there are no specific situations or conditions where the use of Prussian blue is strictly prohibited based on the manufacturer's recommendations.

Warnings and precautions

Discoloration

• One common side effect of taking ferric hexacyanoferrate (Prussian blue) is that it can cause changes in the color of bodily fluids and tissues.
• Specifically, feces may turn blue after taking Prussian blue.
• Additionally, if the contents of the capsules are opened and consumed with food, the oral mucosa (the lining of the mouth) and the teeth may also become colored blue.
• These discolorations are temporary and are not typically a cause for concern, but it's important to be aware of them when taking Prussian blue.

Cardiac arrhythmias:

• Prussian blue, also known as ferric hexacyanoferrate, should be used cautiously in individuals with preexisting cardiac arrhythmias (irregular heartbeats).
• This caution is necessary because Prussian blue may potentially lead to electrolyte imbalances, which can affect the heart's rhythm.
• Therefore, individuals with known heart rhythm disorders should be closely monitored when using Prussian blue to ensure that any electrolyte imbalances are promptly addressed and to prevent the occurrence of cardiac arrhythmias.

Electrolyte imbalances:

• Prussian blue, also known as ferric hexacyanoferrate, can bind to electrolytes in the gastrointestinal tract, potentially leading to electrolyte imbalances.
• Therefore, caution should be exercised when administering Prussian blue to patients who already have existing electrolyte imbalances. Close monitoring of electrolyte levels and appropriate management may be necessary to prevent further imbalances and associated complications.

Gastric immotility

• Prussian blue, also known as ferric hexacyanoferrate, should be used cautiously in patients with decreased gastric motility (gastric immotility), as it may exacerbate constipation.
• Constipation should be avoided in these patients to prevent increased absorption of radiation from the gastrointestinal tract.
• To mitigate constipation, it is advisable to increase dietary fiber intake or take Prussian blue with a fiber laxative.
• This approach can help regulate bowel movements and minimize the risk of radiation absorption, ensuring the safety and effectiveness of Prussian blue therapy.
• Regular monitoring and management of bowel function are essential in patients with decreased gastric motility who are undergoing treatment with Prussian blue.

Monitoring parameters:

• Bowel Movements: Keep an eye on how often you're going to the bathroom. If you're having trouble, let your doctor know.
• Blood Tests (CBC with Differential and Platelets, Electrolytes): Your blood will be checked weekly to make sure everything is normal.

Before Starting Treatment

• Initial Testing: You'll have tests to see how much cesium or thallium is in your body before starting treatment. This might include whole-body counting, urine, or fecal samples.

During Treatment

• Weekly Tests: Throughout treatment, you'll continue to give urine and fecal samples to check cesium and thallium levels.

After Treatment

• 30-Day Check: After finishing treatment, your doctor will check your body's radiation levels to make sure the treatment worked.

How to administer Ferric hexacyanoferrate (Radiogardase)?

• Opening Capsules: If needed, you can open the capsules and mix the contents with bland food or liquid.
• Taking with Food: It's best to take Prussian blue with food. This can help your body get rid of cesium or thallium more effectively.
• Preventing Constipation: To avoid constipation, increase your dietary fiber intake or take a fiber laxative. This can help regulate your bowel movements while you're taking Prussian blue.

Mechanism of action of Ferric hexacyanoferrate (Radiogardase):

• Ferric hexacyanoferrate, also known as Prussian blue, works by grabbing onto cesium and thallium in your stomach and intestines when you eat or when your body gets rid of them through bile.
• This stops them from being absorbed back into your body.
• Instead, the combined form is passed out of your body in your poop.
• This helps reduce how much thallium you absorb and also lowers how long radioactive cesium stays in your body.

Absorption

• Ferric Hexacyanoferrate (Prussian Blue): When taken by mouth, it is not absorbed by the body.

Half-life Elimination

• Cesium-137:
  • Effective Half-life:
    • Adults: 80 days, decreases by 69% with ferric hexacyanoferrate.
    • Adolescents: 62 days, decreases by 46% with ferric hexacyanoferrate.
    • Children: 42 days, decreases by 43% with ferric hexacyanoferrate.
• Nonradioactive Thallium:
  • Biological Half-life: 8 days; with ferric hexacyanoferrate: 3 days.

Excretion

• Ferric Hexacyanoferrate:
  • It is primarily eliminated in feces (99%) without being changed.Top of Form

International Brand Names of Ferric hexacyanoferrate:

• Radiogardase
• Radiogardase-CS

Ferric hexacyanoferrate Brand Names in Pakistan:

You can check for availability and prices by clicking the WhatsApp link here: https://wa.me/message/HV6M3JGTA6RJB1

Ferric hexacyanoferrate, also known as Prussian blue, is a coordination compound with the chemical formula Fe4[Fe(CN)6]3. It is a dark blue pigment that has been used historically in painting, dyeing, and inks. In addition to its applications in the arts, Prussian blue has been employed in various other fields, including medicine and chemistry.

One of its notable uses is in the treatment of radioactive cesium poisoning. Due to its ability to effectively trap and eliminate cesium ions from the body, Prussian blue has been utilized as a medical intervention in cases of accidental ingestion or exposure to radioactive cesium isotopes.

In analytical chemistry, Prussian blue is also utilized as a reagent for the detection and quantification of certain metal ions. Its distinctive color change in the presence of specific ions makes it useful for qualitative and quantitative analysis.

Ferric hexacyanoferrate (Radiogardase) is used as an antidote that enhances the excretion of Cesium and Thallium from the body by binding to them in the gastrointestinal tract.

Ferric hexacyanoferrate (Radiogardase) Uses:

• Internal contamination:
  • It is indicated for the treatment of patients who have been contaminated or are suspected to have been contaminated with radioactive Cesium and radioactive or nonradioactive thallium.
  • The drug enhances the elimination of these agents.

Ferric hexacyanoferrate (Radiogardase) Dose in Adults

Ferric hexacyanoferrate (Radiogardase) Dose in the Internal contamination with radioactive cesium and/or radioactive or nonradioactive thallium: Oral:

Ferric hexacyanoferrate, also known as Prussian blue, is a medicine used to treat people who have been exposed to radioactive cesium or thallium. Here's how it's used:

• If someone has been exposed to cesium, they might need to take 1 to 3 grams of Prussian blue three times a day.
• It's best to start the treatment as soon as possible after exposure, but it can still work if treatment is delayed.
• Treatment usually lasts for at least 30 days.

Remember, the dosage might be different depending on the situation, so it's important to follow the doctor's instructions.

Ferric hexacyanoferrate (Radiogardase) Dose in Childrens

Ferric hexacyanoferrate (Radiogardase) Dose in Internal contamination with radioactive cesium and/or radioactive or nonradioactive thallium: Oral:

Ferric hexacyanoferrate, also known as Prussian blue, is used to treat people who have been exposed to radioactive cesium or thallium. Here's how it's used in different age groups:

• Children aged 2 to 12 years: They usually take 1 gram of Prussian blue three times a day.
• Adolescents (people aged 12 and older): They usually take the same dose as adults.

It's important to start treatment as soon as possible after exposure, but it can still work even if treatment is delayed. Treatment typically lasts for at least 30 days. Make sure to follow the doctor's instructions carefully.

Pregnancy Risk Factor C

• Ferric hexacyanoferrate, also known as Prussian blue, has been assigned a Pregnancy Risk Factor C.
• Animal studies regarding its effects on pregnancy haven't been conducted.
• However, because it's not absorbed by the body from the gut, it's not expected to harm the fetus.
• On the other hand, cesium-137 and thallium can pass through the placenta and potentially harm the developing baby, with reported cases of fetal death and growth problems.
• Despite this, the risk of toxicity from cesium or thallium exposure is considered higher than any risk from ferric hexacyanoferrate.
• Overall, when considering using antidotes like ferric hexacyanoferrate during pregnancy, doctors weigh the benefits against potential risks, ensuring the health of the mother remains a priority.
• They shouldn't avoid using antidotes due to concerns about harming the baby unless absolutely necessary.

Use during breastfeeding:

• The excretion of ferric hexacyanoferrate, or Prussian blue, in breast milk is not known, but it's not expected to happen.
• However, cesium and thallium, which are radioactive or toxic substances, can pass into breast milk.
• Therefore, mothers who are internally contaminated with cesium or thallium should not breastfeed their babies to prevent them from being exposed to these harmful substances.

Dose in Kidney Disease:

• The manufacturer's labeling does not specify any dosage adjustments for ferric hexacyanoferrate, also known as Prussian blue, because it is not absorbed into the body's system.
• This means that the amount of Prussian blue taken orally does not have an impact on the body's overall functioning since it remains in the gastrointestinal tract and is not absorbed into the bloodstream.
• Therefore, there is no need to adjust the dosage based on factors like age, weight, or medical conditions, as it primarily acts within the digestive system to bind with certain substances.

Dose in Liver disease:

• The manufacturer's labeling doesn't suggest any dosage adjustments for ferric hexacyanoferrate (Prussian blue).
• However, it's worth noting that its effectiveness might be reduced if there's a decrease in the biliary excretion of cesium and thallium.
• This means that if the body's ability to eliminate cesium and thallium through bile is impaired, Prussian blue might not work as effectively in trapping and removing these substances.

Side effects of Ferric hexacyanoferrate (Radiogardase):

• Gastrointestinal:
  • Constipation
  • Fecal discoloration (blue)
  • Fastric distress
• Endocrine & metabolic:
  • Hypokalemia

Contraindications to Ferric hexacyanoferrate (Radiogardase):

• The manufacturer's labeling does not list any contraindications for ferric hexacyanoferrate (Prussian blue).
• This means that there are no specific situations or conditions where the use of Prussian blue is strictly prohibited based on the manufacturer's recommendations.

Warnings and precautions

Discoloration

• One common side effect of taking ferric hexacyanoferrate (Prussian blue) is that it can cause changes in the color of bodily fluids and tissues.
• Specifically, feces may turn blue after taking Prussian blue.
• Additionally, if the contents of the capsules are opened and consumed with food, the oral mucosa (the lining of the mouth) and the teeth may also become colored blue.
• These discolorations are temporary and are not typically a cause for concern, but it's important to be aware of them when taking Prussian blue.

Cardiac arrhythmias:

• Prussian blue, also known as ferric hexacyanoferrate, should be used cautiously in individuals with preexisting cardiac arrhythmias (irregular heartbeats).
• This caution is necessary because Prussian blue may potentially lead to electrolyte imbalances, which can affect the heart's rhythm.
• Therefore, individuals with known heart rhythm disorders should be closely monitored when using Prussian blue to ensure that any electrolyte imbalances are promptly addressed and to prevent the occurrence of cardiac arrhythmias.

Electrolyte imbalances:

• Prussian blue, also known as ferric hexacyanoferrate, can bind to electrolytes in the gastrointestinal tract, potentially leading to electrolyte imbalances.
• Therefore, caution should be exercised when administering Prussian blue to patients who already have existing electrolyte imbalances. Close monitoring of electrolyte levels and appropriate management may be necessary to prevent further imbalances and associated complications.

Gastric immotility

• Prussian blue, also known as ferric hexacyanoferrate, should be used cautiously in patients with decreased gastric motility (gastric immotility), as it may exacerbate constipation.
• Constipation should be avoided in these patients to prevent increased absorption of radiation from the gastrointestinal tract.
• To mitigate constipation, it is advisable to increase dietary fiber intake or take Prussian blue with a fiber laxative.
• This approach can help regulate bowel movements and minimize the risk of radiation absorption, ensuring the safety and effectiveness of Prussian blue therapy.
• Regular monitoring and management of bowel function are essential in patients with decreased gastric motility who are undergoing treatment with Prussian blue.

Monitoring parameters:

• Bowel Movements: Keep an eye on how often you're going to the bathroom. If you're having trouble, let your doctor know.
• Blood Tests (CBC with Differential and Platelets, Electrolytes): Your blood will be checked weekly to make sure everything is normal.

Before Starting Treatment

• Initial Testing: You'll have tests to see how much cesium or thallium is in your body before starting treatment. This might include whole-body counting, urine, or fecal samples.

During Treatment

• Weekly Tests: Throughout treatment, you'll continue to give urine and fecal samples to check cesium and thallium levels.

After Treatment

• 30-Day Check: After finishing treatment, your doctor will check your body's radiation levels to make sure the treatment worked.

How to administer Ferric hexacyanoferrate (Radiogardase)?

• Opening Capsules: If needed, you can open the capsules and mix the contents with bland food or liquid.
• Taking with Food: It's best to take Prussian blue with food. This can help your body get rid of cesium or thallium more effectively.
• Preventing Constipation: To avoid constipation, increase your dietary fiber intake or take a fiber laxative. This can help regulate your bowel movements while you're taking Prussian blue.

Mechanism of action of Ferric hexacyanoferrate (Radiogardase):

• Ferric hexacyanoferrate, also known as Prussian blue, works by grabbing onto cesium and thallium in your stomach and intestines when you eat or when your body gets rid of them through bile.
• This stops them from being absorbed back into your body.
• Instead, the combined form is passed out of your body in your poop.
• This helps reduce how much thallium you absorb and also lowers how long radioactive cesium stays in your body.

Absorption

• Ferric Hexacyanoferrate (Prussian Blue): When taken by mouth, it is not absorbed by the body.

Half-life Elimination

• Cesium-137:
  • Effective Half-life:
    • Adults: 80 days, decreases by 69% with ferric hexacyanoferrate.
    • Adolescents: 62 days, decreases by 46% with ferric hexacyanoferrate.
    • Children: 42 days, decreases by 43% with ferric hexacyanoferrate.
• Nonradioactive Thallium:
  • Biological Half-life: 8 days; with ferric hexacyanoferrate: 3 days.

Excretion

• Ferric Hexacyanoferrate:
  • It is primarily eliminated in feces (99%) without being changed.Top of Form

International Brand Names of Ferric hexacyanoferrate:

• Radiogardase
• Radiogardase-CS

Ferric hexacyanoferrate Brand Names in Pakistan:

Not available.