Binding of some therapeutic drugs and essential nutrients is possible.
Monitor the serum levels and or clinical response to critical oral products.

Lab test abnormalites- Prussin blue may bind to electrolytes found in the GI tract..
Excercise caution when treating patients with preexisting cardiac arrhythmias or electrolye imbalance.

Internal Contamination-
For treatment of patients with known or internal contamination with radioactive cesium and or
radioactive or non-radioactive thallium to increase their rate of elimination.

GI - constipation is reported.
       Undefined gastric reported in some patients.
       In these patients the dose was reduced to 10g/day for continued treatment

Special Precautions-
Radiation toxicity- prussian blue is administered to decrease radiation exposure.
It does not treat complication of radiation exposure.
Give supportive treatment for radiation toxicity symptoms concomittantly with Prussian blue
insoluble treatment.

Contamination with multiple radioactive elements- Prussian blue insoluble  may not bind all
radioactive elements. and some radioactive elements may not undergo  enterohepatic
circulation, which is needed for prussian blue insoluble binding and elimination.
Patients contaminated with unkown or multiple radioactive elements may require treatment
with other agents.

GI effects- Prussian blue may cause constipation.Constipation occuring during Prussian blue
treatment may be treated with a fiber-based laxative and or high fiber diet.
Use prussian blue with caution in patients with disorders associated with decreased
GI motility

Special risk- excercise caution when treating patients with preexisting cardiac arrhythmias or
electrolyte imbalances. Prussian blue may bind to oral therapeutic drugs.

Pregnancy- the risk of toxicity from untreated radioactive cesium  or thallium exposure is
expected to be more than the reproductive toxicity risk of prussian blue insoluble

Lactation- woman internally contaminated with cesium or thallium should not breast feed.

Children- the dose related adverse effects of prussian blue insoluble on immature GI tract
are not known. Dosing in infants and neonates has not been established

Monitoring- closely monitor serum electrolytes during prussian blue treatment. Prussian blue may
bind to some therapeutic drugs.

Indication-
Internal Contamination
For trreatment of patients with known or internal contamination with radioactive cesium and or
radioactive or non-radioactive thallium to increase their rate of elimination.

Dosage-
Adults and adolesence - recommended dose is 3g orally 3 times a day.

Children- 2 to 12 years of age- recommended dose of Prussian Blue insoluble is 1g orally 3 times
a day.

In patients who can not swallow tolerate swallowing a large number of capsules , the capsule may be
opened and mixed with bland food or liquid.  This may result in blue discoloration of the mouth
and teeth.
Prussian blue insoluble capsules may be taken with food to stimulate excretion of caesium and
thalium.

1. Cesium -137 is excreted in the urine and feces. Take appropiate safety measures to mininimize
    radiation exposure to others.

2. When possible a toilet should be used instrad of an urinal and it should be flushed several times
    after each use .

3. Spilled urine or feces should be cleaned promptly and patients should wash their  hands
   throughly.

4. If blood or urine gets onto clothing such clothing should be washed separately

5. Parents and caregivers should take extra precaution in handling the urine and feces of
    pediatric patients . Care is intended to prevent re-exposure to the adult and pediatric patient

6. In patients with constipation, a fiber-based laxative and or high fiber diet is recommended
    during treatment with Prussian Blue .

7. Inform patients that their stools might be blue in color.

8. If patients cannot swallow capsules, when the capsules are opened and the contents are
   mixed with food and eaten , the mouth and teeth might be colored blue.

Pharmacology-
Prussian Blue insoluble ferrc III  hexacyanoferrate II is not absorbed through the intact GI wall
after oral ingestion. Its clearance from the body depends on the GI trasnit time

In patients who can not swallow tolerate swallowing a large number of capsules , the capsule may be
opened and mixed with bland food or liquid.  This may result in blue discoloration of the mouth
and teeth.
Prussian blue insoluble capsules may be taken with food to stimulate excretion of caesium and
thalium.

Pregnancy-
The risk of toxicity from untreated radioactive cesium  or thallium exposure is
expected to be more than the redroductive toxicity risk of prussian blue insoluble

Lactation-
Woman internally contaminated with cesium or thallium should not breast feed.

Children-
The dose related adverse effects of prussian blue insoluble on immature GI tract
are not known. Dosing in infants and neonates has not been established