Based on animal data, 99% of a single dose of 40 mg of labeled insoluble Prussian blue was excreted unchanged in feces 9. It predominantly depends on fecal excretion, and does not depend on renal elimination. Prussian blue does not undergo hepatic metabolism use of the drug is not contraindicated in patients with hepatic impairment 9. No evidence of decomposition after oral ingestion 7. Histopathological examination of different organs showed no deposits of prussian blue after oral administration of insoluble prussian blue 9. Prussian blue is not systemically bioavailable 9. A small amount (approximately 2%) of the hexacyanoferrate ion was absorbed after oral ingestion of prussian blue but with no signs of decomposition. Systemic absorption is assumed to be insignificant, with minimal release of cyanide from the complex. It is poorly or not absorbed from the gastrointestinal tract walls after oral ingestion. The rate of cesium and thallium elimination is proportional to the dose and duration of prussian blue. Insoluble prussian blue decreases the half life of cesium by 33% and from 3.8 to 2.2 days for thallium 3. The insoluble complex is excreted without being absorbed from the intestinal walls. Prussian blue exchanges potassium for cesium or thallium at the surface of the crystal in the intestinal lumen. It serves as an ion exchanger for univalent cations and it preferentially binds to cesium or thallium as its affinity for cations increases as the ionic radius of the cation increases 1. Prussian blue binds cesium and thallium isotopes in the gastrointestinal tract after ingestion or excreted in the bile by the liver, therby reduces gastrointestinal reabsorption into the enterohepatic circulation. Data suggest that in humans, Prussian blue can reduce cesium’s half-life by approximately 43% and reduce total body burdens by significantly increasing the feces-to-urine excretion ratio 4. The antidote therapy greatly minimizes the extent of contamination and reduces the half life of radioactive isotopes which have relatively long physicall half life and uniform tissue distribution. It acts by ion-exchange, adsorption, and mechanical trapping within the crystal structure and has a very high affinity for radioactive and non-radioactive cesium and thallium. Prussian blue is an insoluble radioactive metals chelating agent and absorbent.
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