sodium thiosulfate, sodium nitrite, & amyl nitrite (Discontinued)

  • Print
Brand and Other Names:cyanide antidote kit

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

Discontinued from United States market May 2012

per kit

  • sodium thiosulfate injection: 12.5g/50mL (2 vials)
  • sodium nitrite: 300mg/10mL (2 ampules)
  • amyl nitrite inhalant: 0.3mL (12 ampules)
more...

Cyanide Poisoning (Orphan)

Crush 0.3 mL ampul of amyl nitrite q1min and inhale vapor for 15-30 seconds until IV sodium nitrite infusion available

Following infusion of 300 mg or 10 mg/kg IV sodium nitrate, over 2-5 minutes, inject 12.5 g sodium thiosulfate IV over 10 minutes PRN; may repeat both injections at 1/2 original dose 

Other Information

Vasopressors should be available to treat shock

Currently manufactured by Akorn, Inc, Buffalo Grove, IL (1-800-535-7155)

Many clinicians will administer only sodium thiosulfate portion if concerned of concomitant carboxyhemoglobinemia, or if ingestion is uncertain

Other Indications & Uses

Smoke inhalation with acidosis

Dosage Forms & Strengths

Discontinued from United States market May 2012

per kit

  • sodium thiosulfate injection: 12.5g/50mL (2 vials)
  • sodium nitrite: 300mg/10mL (2 ampules)
  • amyl nitrite inhalant: 0.3mL (12 ampules)
more...

Cyanide Poisoning

Administer amyl nitrite as in adults; crush 0.3 mL ampul of amyl nitrite q1min and inhale vapor for 15-30 seconds until IV sodium nitrite infusion available

Follow amyl nitrite administration with sodium nitrate 10 mg/kg (0.33 mL/kg or 6-8 mL/sq.meter of 3% solution; not to exceed 10 mL) 

Inject sodium thiosulfate IV 7 g/sq.meter over 10 minutes; not to exceed 12.5 g; may repeat both injections at 1/2 original dose

Next:

Adverse Effects

Frequency Not Defined

Precipitaiton of methemoglobinemia

Worsening hypoxia

Hypotension (sodium nitrite)

ADR's of nitrite Rx above include hypotension, tachycardia, HA, severe methemoglobinemia

Previous
Next:

Pharmacology

Mechanism of Action

Nitrites create methemoglobins to bind to cyanide

sodium thiosulfate

  • Primary route of endogenous cyanide detoxification is by enzymatic transulfuration to thiocyanate (SCN-), which is relatively nontoxic and readily excreted in the urine
  • Thought to serve as a sulfur donor in the reaction catalyzed by the enzyme rhodanese, thus enhancing the endogenous detoxification of cyanide

sodium nitrite and amyl nitrite

  • Reacts with hemoglobin to form methemoglobin, an oxidized form of hemoglobin incapable of oxygen transport but with high affinity for cyanide
  • Cyanide preferentially binds to methemoglobin over cytochrome a3, forming the nontoxic cyanomethemoglobin
  • Vasodilation has also been cited to account for at least part of the therapeutic effect of amyl nitrite and sodium nitrite
Previous
Next:

Images

Previous
Next: