The Food and Drug Administration (FDA) has added warnings to the labeling of cesium chloride, a nonradioactive mineral salt used in oral or injected form as an alternative to traditional cancer treatment (a radioactive form of cesium is used in radiation therapy). The FDA has now moved cesium chloride to a category of "bulk drug substances" that pose a significant safety risk and should not be used in compounding medications. Compounding is often done when a patient is allergic to an element in a prescribed drug for which is there is no approved replacement.

The FDA's action is based on its review of five case reports submitted to the agency and 18 case reports published in the medical literature of adverse effects related to cesium. These adverse effects included QT prolongation (the most frequently reported adverse effect), low potassium levels, seizures, other potentially lethal arrhythmias, fainting, and cardiac arrest. Six deaths were reported, two of which occurred within 24 hours of cesium injection and which the FDA deemed possibly related to cesium.

The drug is easily accessible on the Internet, in both oral forms and crystals used in compounding, through general searching or even on sites like Amazon.

Patients whose cancer has not been controlled by or who do not wish to use standard cancer treatment may seek alternative treatments for their disease. They may be victimized by unscrupulous individuals who sell or promote nonapproved substances purported to be safe and "natural" cures for cancer. Nurses and other health care professionals should be aware of the risks related to cesium, particularly cardiovascular risk, and assess patients for their use of the product. It is important for nurses to provide patients and their families with information on how to identify reputable websites that provide accurate information about cancer and effective treatments.

The FDA alert on cesium chloride can be found at http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/PharmacyCompoun. Adverse effects associated with cesium chloride should be reported to the FDA's MedWatch adverse event reporting system at http://www.fda.gov/Safety/MedWatch/default.htm.