Pharmacologic Therapy for Radiation Injury

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]}

Enteral binding agents

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

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