Pharmacologic Therapy for Radiation Injury 

Updated: Aug 13, 2015
  • Author: Lars J Grimm, MD, MHS; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
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Agents for Treating Radiation-Exposure Injury

Detailed information about medical treatment for radiation injury can be found at the Oak Ridge Institute for Science and Education. A review was published in June 2015 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]

Enteral binding agents

Barium sulfate: [2]

  • 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

Blockade of end-organ uptake

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

Dilution

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

Chelation

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

Decrease organ damage

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