Food enhances effectiveness by stimulating bile production and enterohepatic circulation.
Route/Dosage⬆⬇
PO (Adults ): 3 g three times daily continued for a minimum of 30 days, with assessment of internal radioactivity. If radioactivity has decreased, dosage may be reduced to 1–2 g three times daily.
PO (Children 2–12 yr): 1 g three times a day.
Availability⬆⬇
Capsules: 0.5g
Assessment⬆⬇
Assess patient for signs of radiation toxicity (bone marrow suppression with severe neutropenia and thrombocytopenia).
Lab Test Considerations:
Measure and record radioactivity counts in urine and fecal samples at baseline and weekly to monitor 137Cs elimination rate. When internal radioactivity is substantially decreased the insoluble Prussian blue dose may be decreased to improve GI tolerance.
Monitor CBC, serum chemistry and electrolytes closely during therapy. May cause asymptomatic hypokalemia.
Implementation⬆⬇
Health professional should follow appropriate radiation protection attire and procedures at all times. Control spread of radiation contamination through establishment of a patient triage site, patient decontamination area, and a contaminated or “dirty” material dumpsite. Proper labeling, handling, and disposal of contaminated material needs to be established and followed.
PO: Capsules may be taken with food to stimulate excretion of cesium or thallium. Inform patients who cannot swallow capsules, that when capsules are opened and contents are mixed with food and eaten, the mouth and teeth might be colored blue.
Patient/Family Teaching⬆⬇
Instruct patient to take medication as directed.
Caution patient regarding safety measures to minimize radiation exposure to others. When possible, use a urinal and flush several times after each use. Spilled urine or feces should be cleaned up completely and patients should wash their hands thoroughly. If blood or urine gets onto clothing, such clothing should be washed separately. Parents and child care givers should take extra precautions handling the urine and feces of pediatric patients to prevent re-exposure to the adult and pediatric patient.
Inform patients that stools might be blue-colored. Advise patient to use a high fiber diet and a bulk-forming laxative to prevent and treat constipation.