Pharmacologic Therapy for Radiation Injury 

Pharmacologic Therapy for Radiation Injury 

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Detailed information about medical treatment for radiation injury can be found at the Oak Ridge Institute for Science and Education. Reviews were published in 2015 and 2016 by Singh and colleagues on radiation medical countermeasures, including therapies currently available for use, those that might be used for exceptional nuclear/radiological contingencies, and current experimental efforts. [1, 2]

Barium sulfate [3] :

Adult dose: 200 mL PO x 1 dose

Binds with strontium and radium

Aluminum and magnesium salts (Maalox, Mylanta):

Adult dose: 100 mL PO x 1 dose

Binds with strontium, radium, and phosphorous

Activated charcoal:

Adult dose: 50-100 g PO x 1 dose

Potassium iodide

Adult dose:

130 mg PO daily (maximum: 1 dose in 24h)

Duration of therapy: Continue daily dose until exposure risk has passed and/or until other measures (eg, evacuation, sheltering, control of the food and milk supply) have been successfully implemented

Blocks thyroid uptake of iodine and technetium

Pediatric dose:

Infants < 1mo: 16.25 mg PO daily

1mo to 3y: 32.5 mg PO daily

3-18y: 65 mg PO daily

Adolescents >70 kg (154 lb): 130 mg PO daily

≥ 18y: 130 mg PO daily (same as adults)

Duration of therapy: Continue daily dose until exposure risk has passed and/or until other measures (eg, evacuation, sheltering, control of the food and milk supply) have been successfully implemented

Blocks thyroid uptake of iodine and technetium

Calcium gluconate:

Adult dose: 3 g IV x 1 dose

Blockade into bone by increasing urinary excretion of radioactive strontium and calcium

Calcium chloride:

Adult dose: 1 g IV x 1 dose

Blockade into bone by increasing urinary excretion of radioactive strontium and calcium

Oral fluids:

Adult dose: 5-10 L PO/IV daily x 1wk

Excretion of tritium

Neutra Phos:

Adult dose: 1 packet (diluted) PO QID x 3d

Excretion of phosphorus

K Phos:

Adult dose:

2 tablets PO QID x 3d

Excretion of phosphorus

Pediatric dose:

>4y: 1-2 tablets PO QID

≤ 4y: Safety and efficacy not established

Excretion of phosphorus

Pentetate trisodium salts(DTPA; Ca-DTPA within 24h, Zn-DTPA after 24h)

Adult dose:

1 g IV in 250 mL saline/D5W daily

Chelates americium, uranium, plutonium, heavy metals

Pediatric dose:

≤ 12y: 14 mg/kg IV daily initially (maximum 1 g/day); maintenance 14 mg/kg/day (maximum 1 g/day)

>12y: 1 g IV in 250 mL saline/D5W daily (same as adults)

Chelates americium, uranium, plutonium, heavy metals

Penicillamine:

Adult dose:

250-500 mg PO QID

Chelates cobalt

Pediatric dose:

20-40 mg/kg/day PO divided q8h

Chelates cobalt

Prussian blue:

Adult dose:

3 g PO TID; minimum 30-day treatment; may decrease dose to 1-2 g TID after internal radioactivity is substantially reduced to improve GI tolerance

Chelates cesium and thallium

Pediatric dose:

< 2y: safety and efficacy not established

2-12y: 1 g PO TID; minimum 30-day treatment

>12y: 3 g PO TID; minimum 30-day treatment (same as adults)

Chelates cesium and thallium

Sodium bicarbonate:

Adult dose: 2 mEq/kg IV x 1 dose, then mix 4 ampules (44.6 mEq/50 mL ampule/vial) in 1L of D5W titrated to urinary pH of 6.5-7.5

Nephroprotective for uranium

Singh VK, Romaine PL, Seed TM. Medical Countermeasures for Radiation Exposure and Related Injuries: Characterization of Medicines, FDA-Approval Status and Inclusion into the Strategic National Stockpile. Health Phys. 2015 Jun. 108(6):607-30. [Medline].

Singh VK, Romaine PL, Newman VL, Seed TM. Medical countermeasures for unwanted CBRN exposures: part II radiological and nuclear threats with review of recent countermeasure patents. Expert Opin Ther Pat. 2016 Dec. 26 (12):1399-1408. [Medline].

Warfare – Chemical, Biological, Radiological, Nuclear And Explosives. Medscape Drugs & Diseases. Available at https://emedicine.medscape.com/emergency_medicine. Accessed: August 30, 2018.

Lars J Grimm, MD, MHS Assistant Professor, Department of Diagnostic Radiology, Duke University Medical Center

Disclosure: Nothing to disclose.

Jeanne S Pae, MD Emergency Medicine Physician, Emergency Room Group, Ltd., Ocean Springs, MS

Jeanne S Pae, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents’ Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Zygmunt F Dembek, PhD, MPH, MS, LHD Associate Professor, Department of Military and Emergency Medicine, Adjunct Assistant Professor, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine

Zygmunt F Dembek, PhD, MPH, MS, LHD is a member of the following medical societies: American Chemical Society, New York Academy of Sciences

Disclosure: Nothing to disclose.

Pharmacologic Therapy for Radiation Injury 

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