sodium thiosulfate, sodium nitrite, and amyl nitrite (cyanide antidote kit)
Classes: Cyanide Antidotes
Dosing and uses of Cyanide antidote kit (sodium thiosulfate, sodium nitrite, and amyl nitrite)
Adult dosage forms and 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)
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
Pediatric dosage forms and 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)
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
Cyanide antidote kit (sodium thiosulfate, sodium nitrite, and amyl nitrite) adverse (side) effects
Frequency not defined
Precipitaiton of methemoglobinemia
Worsening hypoxia
Hypotension (sodium nitrite)
ADR's of nitrite Rx above include hypotension, tachycardia, HA, severe methemoglobinemia
Pharmacology of Cyanide antidote kit (sodium thiosulfate, sodium nitrite, and amyl nitrite)
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
