Pentetate Calcium Trisodium Dosage

Applies to the following strengths: 200 mg/mL

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 welcome@hm-ph.com

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.