Usual Adult Dose for Radiation Emergency

Initial dose: 1 gram, intravenously
Maintenance dose (if pentetate zinc disodium is unavailable): 1 gram, intravenously
Maximum dose: 1 dose per 24 hour period

Comments:

• Administer during the first 24 hours after internal contamination; it is more effective than pentetate zinc disodium during this period.
• If additional chelation is indicated, pentetate zinc disodium is the preferred agent.
• May use for additional chelation if pentetate zinc disodium is not available; administer concomitant mineral supplements containing zinc.

Use: Treatment of known or suspected internal contamination with plutonium, americium, or curium to increase the rates of elimination.

Usual Pediatric Dose for Radiation Emergency

12 years and older:
Initial dose: 1 gram, intravenously
Maintenance dose (if pentetate zinc disodium is unavailable): 1 gram, intravenously
Maximum dose: 1 dose per 24 hour period

Under 12 years:
Initial dose: 14 mg/kg (not to exceed 1 gram), intravenously
Maintenance dose (if pentetate zinc disodium is unavailable): 14 mg/kg (not to exceed 1 gram), intravenously
Maximum dose: 1 dose per 24 hour period

Comments:

• Administer during the first 24 hours after internal contamination; it is more effective than pentetate zinc disodium during this period.
• If additional chelation is indicated, pentetate zinc disodium is the preferred agent.
• May use for additional chelation if pentetate zinc disodium is not available; administer concomitant mineral supplements containing zinc.

Use: Treatment of known or suspected internal contamination with plutonium, americium, or curium to increase the rates of elimination.

Renal Dose Adjustments

No adjustment recommended.

• Renal impairment may reduce the rate at which radiocontaminants are removed.
• Dialysis may be used to increase the rate of elimination in heavily contaminated patients.
• High efficiency flux dialysis is recommended.
• Dialysis fluid will become radioactive; use radiation precautions to protect others.

Liver Dose Adjustments

Data not available

Precautions

US BOXED WARNINGS:
ASTHMA EXACERBATION WITH NEBULIZATION and DEPLETION OF TRACE METALS DURING THERAPY

• Nebulized pentetate calcium trisodium may be associated with asthma exacerbation.
• This drug is associated with depletion of trace metals such as zinc.
• The magnitude of trace metal depletion increases with split daily dosing, increasing dose, and increased treatment duration.
• Only one dose of pentetate calcium trisodium is recommended.
• Use pentetate zinc if additional chelation therapy is indicated.
• Monitor serum zinc, serum creatinine, BUN, electrolytes, urinalysis, and blood cell counts during therapy.

COLLECTION OF PATIENT DATA

• Provide detailed treatment information (to gather long-term response and malignancy data).
• A form is attached to the prescribing information.
• Forms can be found at: www.ca-dtpa.com
• Include radioactive body burden, bioassay results, measurement methods, and adverse events.

Questions on use of this product, and on treatment of internal radiation may be referred to the manufacturer at [email protected]

Consult WARNINGS section for additional precautions.

Dialysis

No adjustment recommended

• Dialysis may be used to increase the rate of elimination in heavily contaminated patients.
• High efficiency flux dialysis is recommended.
• Dialysis fluid will become radioactive; use radiation precautions to protect others.

Other Comments

Administration advice:

• Administer IV if route of internal contamination is unknown or multiple routes are likely.
• May give slow push over 3 to 4 minutes, or infusion.
• Patients with ONLY inhalation contamination within 24 hours: may nebulize at a 1:1 ratio with sterile water or saline. After nebulization, patients should avoid swallowing any expectorant.
• Pediatrics: safety and efficacy of nebulized treatment has not been established.

Reconstitution/preparation techniques:

• Dilute with 5% dextrose in water (D5W), lactated Ringers solution, or normal saline.
• Slow push: 1 gram in 5 mL
• Infusion: 1 gram in 100 to 250 mL

General:

• If contamination is with something other than plutonium, americium, or curium, or contaminants are unknown, additional therapies may be needed (e.g. Prussian blue, potassium iodide).

Monitoring:

• The manufacturer product information should be consulted.

Patient advice:

• Drink plenty of fluids and void frequently (to dilute and minimize bladder exposure).
• Use a toilet rather than a urinal; flush several times after each use.
• Wash hands thoroughly after cleaning up spilled urine or feces.
• Wash clothing or linens separately if they get blood or urine on them.
• Dispose of expectorant carefully; avoid swallowing it.