Deaths or serious or severe adverse events attributed to insoluble Prussian blue have not been reported. Constipation was reported in 10/42 (24%) patients in the Goiânia accident treated with insoluble Prussian blue. Severity of constipation was mild in 7 patients and moderate in 3 patients. Constipation was successfully treated with a high fiber diet.

Undefined gastric distress was reported in 3 patients treated with 20 gram/day of insoluble Prussian blue. In these patients the dose was reduced to 10 gram/day for continued treatment.

Adequate and well-controlled drug-drug interaction studies in humans were not identified in the literature. In preliminary studies, animals were contaminated with several different radioisotopes and treated with several different radioeliminators. Based on these animal data, co-administration of Prussian blue with other radioeliminators does not affect the efficacy of Prussian blue for ¹³⁷Cs.

Binding to some therapeutic drugs and essential nutrients is possible. The literature contains anecdotal reports of asymptomatic hypokalemia and decreased bioavailability of oral tetracycline. The serum levels and, or clinical response to critical orally administered products should be monitored.

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