Radiation Countermeasures for

Treatment of Internal Contamination

Medical countermeasure information in this table adapted from:

• Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report

No. 161, Vol. I), National Council on Radiation Protection and Measurements,
Bethesda, MD, 2008.
• Population Monitoring and Radionuclide Decorporation Following a Radiological or
Nuclear Incident (NCRP Report No. 166), National Council on Radiation Protection and
Measurements, Bethesda, MD, 2011.
• FDA drug information related to radiation emergencies

Caveats about Radiation Countermeasures for Treatment of Internal Contamination

Mecha- Route of
Medical Adminis- References for
nism of adminis- Dosage Duration of treatment
countermeasure tered for use
action tration

Aluminum carbonate Phospho- Phosphate PO 600 mg tablet TID NCRP-suggested

rus (P-32) binder or 400mg/5 cc TID

Aluminum hydroxide Radium Blocks PO Adults: 60-100 mL Give one dose within 24 NCRP-preferred
(Ra-226) intestinal (1200 mg) hr of radionuclide intake
absorption to block intestinal
Strontium Children: 50 absorption; administer
(Sr-90) mg/kg, not to before absorption occurs
exceed the adult
dose

Phospho- Phosphate PO 600 mg tablet TID NCRP-suggested

rus (P-32) binder or

320 mg/5cc TID

Barium sulfate Radium Blocks PO 100-300 g (as a Give one dose within 24 NCRP-suggested
(Ra-226) intestinal single dose in 250 hr of radionuclide intake
absorption cc water) to block intestinal
Strontium absorption; administer
(Sr-90) before absorption occurs

Calcium carbonate Radium Competes for PO Use as directed on Begin therapy within 12 NCRP-suggested
(Ra-226) bone binding label hr of radionuclide intake
sites if possible
Strontium
(Sr-90)
Calcium gluconate Radium Competes for IV 5 ampoules (500 6 days; begin therapy NCRP-suggested
(Ra-226) bone binding mg Ca/amp) in within 12 hr of
sites; 500 cc 5% radionuclide intake if
Strontium phosphate dextrose in water possible
(Sr-90) binder (D5W); infuse
over 4-6 hours

Calcium phosphate Radium Increases PO 1200 mg Give one dose within 24 NCRP-suggested
(Ra-226) excretion hr of radionuclide intake
to block intestinal
Strontium absorption; administer
(Sr-90) before absorption occurs

Deferoxamine (DFOA) Plutonium Chelating IM 2 ampoules (500 NCRP-suggested

(Pu-239) agent (preferred mg DFOA/amp)
• Give a single dose,
route) then DFOA is FDA-
approved for Rx of
obtain bioassayto acute and chronic
IV (slow 2 ampoules (500 iron poisoning only
assess residual
infusion) mg DFOA/amp) at
15 mg/kg/hr body burden of Pu-
239

• Repeat as
indicated: 500 mg
IM (preferred) or IV
q4 hr x2 doses,
then 500 mg IVq12
hr for 3 days

Mecha- Route of
Medical Adminis- References for
nism of adminis- Dosage Duration of treatment
countermeasure tered for use
action tration

DTPA (calcium & zinc) Americium Chelating IV (give Adults: 1 g in 5 cc

(Am-241) agent once daily 5% dextrose in
• Begin treatment
DTPA is FDA-
as a bolus water (D5W) or with Ca-DTPA , then approved for
Californiu or as a 0.9% sodium intravenous Rx of
m (Cf-252) single chloride (normal change to Zn-DTPA known or
infusion, saline, NS) slow IV for maintenance, as suspected internal
Cobalt (Co-
i.e., do not push over 3-4 contamination with
60) indicated
fractionat minutes or 1 g in Am, Cm, and Pu
Curium e the 100-250 cc D5W only
(Cm-244) dose) or NS as an • Duration of therapy
infusion over 30 DTPA is FDA-
depends on total approved for
Plutonium minutes
(Pu-238 body burden and nebulized
and Pu- Children < 12 inhalation in adults
years: 14 mg/kg/d response to only, and if the only
239)
slow IV push over treatment route of
Yttrium (Y- 3-4 minutes (not contamination is
90) to exceed 1 g/day) through inhalation

DTPA is NCRP-
Nebulized 1 g in 1:1 dilution preferred as Rx of
inhalation with sterile water the other isotopes
(for use in or NS over 15-20 listed and NCRP-
adults minutes suggested as a
only)
 Wound 1 g Ca- or Zn-DTPA wound irrigation
irrigation and 10 cc 2%
• Irrigation can be
fluid
fluid lidocaine in 100 cc accompanied by IV
5% dextrose in
water (D5W) or or inhaled DTPA
0.9% sodium
chloride (normal • Amount of DTPA
saline, NS)
absorbed by wound
tissues cannot be
measured

• Avoid overdosing
with DTPA and/or
2% lidocaine

Dimercaprol(BAL) Polonium Chelating IM (300 2.5 mg/kg QID x2 10 days NCRP-preferred

(Po-210) agent mg/vial for days (days 1 & 2),
deep IM then BID x1 day Dimercaprol (BAL)
injection (day 3), then QD is FDA-approved for
only) (days 4-10) Rx of arsenic, gold
and mercury
poisoning and
when used
together with EDTA
for Rx of acute lead
poisoning only

Mecha- Route of
Medical Adminis- References for
nism of adminis- Dosage Duration of treatment
countermeasure tered for use
action tration

EDTA Cobalt (Co- Chelating IV 1000 mg/m2/day Given as a single dose NCRP-suggested
60) agent in 500 cc 5%
dextrose in water EDTA is FDA-
(D5W) or 0.9% approved for Rx of
sodium chloride lead poisoning only
(normal saline,
NS); infuse over 8-
12 hours

IM Divide IV dose Given as a divided dose

equally into two
doses and
administer 8-12
hours apart

D- Polonium Chelating PO Adults: 0.75-1.5 g NCRP-suggested

Penicillamine(DailyMed (Po-210) agent (250 mg/capsule)
• Obtain bioassay to
) QD assess D-Penicillamine is
FDA-approved for
Children: 30 Rx of copper
mg/kg/day (250 • Continue only if poisoning only
mg/capsule) clinically indicated
divided into 4
doses
• D-Penicillamine has
a narrow
therapeutic index;
 use is associated
with high risk of
toxicity

Potassium iodide (KI) Iodine (I- Blocking PO Adults >40 years: FDA-approved
131) agent 130 mg/day (For
• Some incidents will
projected thyroid require only a NCRP-preferred
dose ≥500 cGy)
single dose of KI.
Adults 18 - 40
years: 130 mg/day • Incident managers
(For projected
thyroid dose ≥10 may recommend
cGy) additional daily
Pregnant or doses if ongoing
lactating women
radioactive iodine
of any age: 130
mg/day (For ingestion or
projected thyroid
dose ≥5 cGy) inhalation
represents a
Adolescents ≥70
kg: 130 mg/day continuing threat.
(For projected
thyroid dose ≥5 • See also: Potassium
cGy)
Iodide (KI):
Children &
Duration of
adolescents 3 - 18
years: 65 mg/day Therapy.
(For projected
thyroid dose ≥5
cGy)

Infants & toddlers

1 month - 3 years:
32.5 mg/day (For
projected thyroid
dose ≥5 cGy)

Neonates from
birth - 1 month:
16 mg/day (For
projected thyroid
dose ≥5 cGy)

Mecha- Route of
Medical Adminis- References for
nism of adminis- Dosage Duration of treatment
countermeasure tered for use
action tration

Potassium phosphate Phospho- Phosphate PO 600-1200 mg, NCRP-suggested

rus (P-32) binder given in divided
doses

Potassium phosphate, Phospho- Phosphate PO (take Adults: 1-2 tablets NCRP-suggested

dibasic rus (P-32) binder with full (250 mg/tab) QID
glass of
water with Children >4 years:
meals and 1 tablet (250
mg/tab) QID
 at
bedtime)

Propylthiouracil Iodine (I- Blocking PO Adults: 2 tablets 8 days NCRP-suggested

131) agent (50 mg/tab) TID

Prussian blue, insoluble Cesium Ion exchange; PO Adults, children Prussian blue,
(Cs-137) inhibits >12 years:
• Minimum 30 day
insoluble, is FDA-
enterohepati course per FDA approvedand NCRP
c • 1-3 g (2-6 -preferred for Rx of
recirculation
capsules; 0.5
• Obtain bioassay an known or
in GI tract suspected internal
d whole body contamination with
g insoluble
radioactive Cs
counting to assess
Prussian and/or radioactive
treatment of or non-radioactive
blue per
thallium; FDA-
efficacy
cap) TID; up approved for ages >
2 years old only
to 10-12 • Duration of therapy
g/day depends on total
(based body burden and
on Goiânia response to
incident treatment
data)

• 3 g (6
capsules; 0.5
g insoluble
Prussian
blue per
cap) TID
(see: FDA
Package
Insert )

Children 2 - 12
years:

• 1 g (2
capsules; 0.5
g insoluble
Prussian
blue per
cap) TID

• Capsules
may be
opened and
contents
 mixed with
food

• See: FDA
Package
Insert for
pediatric
prescribing
information

Children <2 years:

Prussian blue is
not FDA-approved
for use (IND
or EUA may be
required)

Mecha- Route of
Medical Adminis- References for
nism of adminis- Dosage Duration of treatment
countermeasure tered for use
action tration

Sevelamer(DailyMed) Phospho- Phosphate PO 5 days if possible; first NCRP-suggested

rus (P-32) binder
• 2-4 tablets
dose is the most
(400 mg - important
800 mg/tab)
TID

• Not to
exceed 1600
mg TID

Sodium alginate Radium Blocks PO (take 5g BID x1 day, NCRP-suggested

(Ra-226) intestinal with a full then 1 g QID
absorption glass of
Strontium water)
(Sr-90)

Sodium bicarbonate Uranium Facilitates IV Administer therapy until NCRP-preferred

(U-235) increased
• 2 ampoules
urine pH is 8-9 ; continue
renal (44.3 mEq Rx for 3 days
excretion
bicarbonate
/ ampoule)
in 1000 cc
5% dextrose
in water
(D5W) or
0.9% sodium
chloride
(normal
saline, NS)
 • 250 cc (1-2
mEq/kg)
slow
infusion

PO 2 tablets Q4 hr

Sodium Phospho- PO 600-1200 mg, NCRP-suggested

glycerophosphate rus (P-32) given in divided
doses

Sodium phosphate Phospho- PO 600-1200 mg, NCRP-suggested

rus (P-32) given in divided
doses

Succimer Polonium Chelating PO Reduce frequency of NCRP-suggested

(DMSA)(DailyMed) (Po-210) agent
• 100 mg
administration to 10
capsules mg/kg or 350 DMSA is FDA-
mg/m2every 12 hr for an approved for the
treatment of lead
• Administer additional 2 weeks of
poisoning only
therapy; typical
10 mg/kg or treatment course: 19
days
350
mg/m2 every
8 hr for 5
days, then
reduce;
safety and
efficacy in
children <12
years has
not been
established

Water Tritium (H- Facilitates PO >3-4 liters/day 3 weeks NCRP-preferred

3) excretion

References for use

FDA approved: Countermeasures so marked have been approved as treatment for internal
contamination with the listed radioisotope by the US Food and Drug Administration (FDA).

NCRP preferred: Countermeasures so marked have been listed as preferred treatments for
internal contamination with the listed radioisotope by the National Council on Radiation
Protection and Measurements [Management of Persons Contaminated with Radionuclides:
Handbook(NCRP Report No. 161, Vol. I)]. Except where noted, use of these
countermeasures has not been approved by the US Food and Drug Administration (FDA).

NCRP suggested: Countermeasures so marked have been listed as suggested treatments

for internal contamination with the listed radioisotope by the National Council on Radiation
Protection and Measurements [Management of Persons Contaminated with Radionuclides:
Handbook (NCRP Report No. 161, Vol. I)]. Use of these countermeasures has not been
approved by the US Food and Drug Administration (FDA).