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Other commonly used names are: Berlin blue; ferric ferrocyanide; ferric (III) hexacyanoferrate (II); iron blue.

• Chelating agent

Prussian (PRUSH-en) blue is used to treat thallium poisoning and radiocesium poisoning. It works by combining with thallium and radiocesium in the intestines. The combination is then removed from the body through the stools. By removing the thallium or radiocesium, the medicine lessens damage to your body's organs and tissues.

Prussian blue is available only with your doctor's prescription, in the following dosage form:

Oral
• Capsules (Germany)

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For prussian blue, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to prussian blue. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Prussian blue has not been shown to cause birth defects or other problems in humans.

Breast-feeding—It is not known whether prussian blue passes into breast milk. However, thallium does pass into breast milk. Mothers with thallium or radiocesium poisoning who wish to breast-feed should discuss this with their doctor.

Children—Although there is no specific information comparing use of prussian blue in children with use in other age groups, this medicine is not expected to cause different side effects or problems in children than it does in adults.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults. Although there is no specific information comparing use of prussian blue in the elderly with use in other age groups, this medicine is not expected to cause different side effects or problems in older people than it does in younger adults.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your health care professional if you are using any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Other medical problems—The presence of other medical problems may affect the use of prussian blue. Make sure you tell your doctor if you have any other medical problems, especially:

• Blockage of the intestines or
• Constipation—This medicine may not work properly if these conditions are present

Keep taking this medicine for the full time of treatment, even if you begin to feel better after a few days. Do not miss any doses.

If you are unable to swallow the capsule, you may open the capsule and empty the contents into a glass (8 ounces) of warm water. Stir gently until the medicine is mixed with the water. Drink the water with the medicine right away. If there is any medicine left in the bottom of the glass, add a little more warm water to the glass and drink that too.

Your doctor may advise you to take this medicine with a laxative, such as sorbitol, to help prevent constipation.

Dosing—

The dose of prussian blue will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of prussian blue. If your dose is different, do not change it unless your doctor tells you to do so.

• For oral dosage form (capsules):
  • For acute thallium poisoning:
    • Adults and children—3 grams taken right away, followed by 3 to 20 grams a day divided into smaller doses as directed by your doctor. Or, the dose may be 3 grams taken right away, followed by 250 milligrams (mg) per kilogram (kg) (113.5 mg per pound) of body weight a day divided into four smaller doses. Either dose may be taken for two to three weeks as determined by your doctor.
  • For chronic thallium poisoning:
    • Adults and children—The usual dose is 3 to 20 grams a day divided into smaller doses as directed by your doctor. Or, the dose may be 250 mg per kg (113.5 mg per pound) of body weight a day divided into four smaller doses. Either dose may be taken for two to three weeks as determined by your doctor.
  • For radiocesium poisoning:
    • Adults and children—The usual dose is 500 mg every two hours, for a total dose of 3000 mg (3 grams) a day. This dose may be taken for as little as several days or as long as three weeks, as determined by your doctor.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Keep the medicine from freezing. Do not refrigerate.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if the following side effect occurs:

• More common
  • Constipation 
  
  

This medicine commonly causes unusually dark stools. This side effect does not usually need medical attention.

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Revised: 04/19/1995