pentetate calcium trisodium

Forms chelates by exchanging for metals with a greater binding ability (radioactive plutonium, americium, or curium). These chelates are then renally excreted.

Therapeutic effects:

Increased rate of removal of radioactive compounds from the body with decreased sequelae of radiation exposure.

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability. 20% absorbed following inhalation.

Distribution: Rapidly distributed into extracellular fluid space.

Metabolism/Excretion: Excreted by glomerular filtration. <3% eliminated in feces.

Half-Life: 94 min.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
IV	rapid	unknown	24 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Lactation: Lactation.

Use Cautiously in:

Renal impairment;
Severe hemochromatosis;
Asthma (inhalation only);
Mixed radiocontamination (additional treatments may be needed);
OB: Pregnancy (use pentetate zinc trisodium unless contamination is high);
Pedi: Children (safety of inhalation not established).

Adv. Reactions/Side Effects ⬆ ⬇

CV: chest pain

Derm: dermatitis

GI: diarrhea, metallic taste, nausea

F and E: depletion of zinc, manganese, magnesium (prolonged treatment)

Local: injection site reactions

Neuro: headache, light-headedness

Resp: cough, wheezing (inhalation only)

Misc: allergic reactions

Interactions ⬆ ⬇

Drug-drug:

None reported.

Route/Dosage ⬆ ⬇

Pentetate calcium trisodium is more effective than pentetate zinc trisodium and should be given as the initial dose in the first 24 hr following internal contamination. After 24 hr, pentetate zinc trisodium is equally effective.

IV (Adults and Children ≥12 yr): 1 g as a single dose; then follow with pentetate zinc trisodium. If pentetate zinc trisodium is unavailable, continue with pentetate calcium trisodium 1 g once daily. Duration of treatment depends on degree of contamination and response.
IV (Children <12 yr): 14 mg/kg as a single dose (max = 1 g/dose); then follow with pentetate zinc trisodium. If pentetate zinc trisodium is unavailable, continue with pentetate calcium trisodium 14 mg/kg once daily. Duration of treatment depends on degree of contamination and response.
Inhaln (Adults ): 1 g as a single dose; then follow with pentetate zinc trisodium. If pentetate zinc trisodium is unavailable, continue with pentetate calcium trisodium 1 g once daily. Duration of treatment depends on degree of contamination and response.

Availability ⬆ ⬇

Solution for injection or inhalation: 200 mg/mL

Assessment ⬆ ⬇

Obtain information regarding contamination with plutonium, americium, or curium.

Lab Test Considerations:

Obtain baseline CBC with differential, BUN, serum chemistries and electrolytes, urinalysis, and blood and urine radioassays, if possible, prior to initiating treatment and regularly thereafter.
- Monitor serum zinc and CBC carefully during therapy. May cause depletion of zinc, magnesium, manganese, and possibly metalloproteinases.
- Obtain a quantitative baseline estimate of total internalized transuranium elements and measures of elimination of radioactivity by whole-body counting, bioassay, or fecal/urine sample when possible. Measure radioactivity in blood, urine, and fecal samplings weekly to monitor contamination elimination rate.

Implementation ⬆ ⬇

Treatment is more effective if administered within the first 24 hr after internal contamination; treat as soon as possible after suspected or known internal contamination.
- Provide detailed information to manufacturer via Patient Data Form to develop long-term response data.
- To open ampule, turn so that point faces up and break off the neck in a downward movement. Do not administer solution that is discolored or contains particulate matter. A filter needle may be used if particles are seen subsequent to opening ampule.
- Only a single dose is recommended. If more than one dose is given, administer mineral supplements containing zinc concomitantly.
Inhaln: If contamination is only via inhalation within the preceding 24 hr, pentetate calcium trisodium can be administered by inhalation. Dilute for nebulization at a 1:1 ratio with sterile water or 0.9% NaCl. Encourage patient to avoid swallowing expectorant following nebulization. Inhalation route may exacerbate asthma.

IV Administration:

IV Push: Diluent: Administer undiluted.
Rate: Administer over 3–4 min.
Intermittent Infusion: Diluent: Dilute in 100–250 mL of D5W, LR, or 0.9% NaCl.
Rate: Administer slowly.
Y-Site Incompatibility: Do not mix with or infuse with other drugs in same line.

Patient/Family Teaching ⬆ ⬇

Instruct patient to drink plenty of fluids and void frequently to promote dilution of the radioactive chelate in the urine and minimize radiation exposure directly to the bladder. When possible, patients should use a toilet instead of a urinal and flush several times after each use.
Advise patient and parents to clean up spilled urine or feces completely and wash hands thoroughly. If blood or urine comes in contact with clothing or linens, wash items separate from other laundry.
Caution patients who are coughing to dispose of expectorant carefully.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇