Dosing and uses of Sodium thiosulfate
Adult dosage forms and strengths
injection solution
- 100mg/mL (10%)
- 250mg/mL (25%)
Cyanide Poisoning
12.5 g IV (infuse over 10-20 minutes)
Cisplatin Extravasation
2 mL 1/6 molar solution through IV cannula for every 100 mg cisplatin; remove needle, then inject 0.1 mL injections clockwise around extravasation area up to 1 mL; repeat several times within the 3-4 hr of extravasation incident
Cisplatin Nephrotoxicity
4 g/m² IV bolus followed by 12 g/m² IV infusion over 6 hr
Preparation of 1/6 Molar Solution
4 mL of 10% solution + 6 mL sterile water for injection
1.6 mL of 25% solution + 8.4 mL sterile water for injection
Orphan Designations
Calciphylaxis: 25 g IV 3 times per week following dialysis for 6 weeks to 9 months; other protocols exist
Mechlorethamine extravasation: 2 mL 10% solution through IV cannula for every 2 mg mechlorethamine extravasated; remove needle, then inject 10 mL of 1/6 molar solution SC
Sulfur mustard poisoning
Dermatomyositis
Orphan sponsor
- Hope Pharmaceuticals; 16416 N. 92nd Street, Suite 125; Scottsdale, AZ 85260
Administration
Monitor for thiocyanate toxicity
Pediatric dosage forms and strengths
injection solution
- 100mg/mL (10%)
- 250mg/mL (25%)
Cyanide Poisoning
7 g/m² IV (maximum 12.5 g), infuse over at least 10 minutes
Platinum-Induced Ototoxicity (Orphan)
Prevention of platinum-induced ototoxicity in pediatric patients
Orphan sponsor
- Adherex Technologies, Inc; 501 Eastowne Dr Suite 140; Chapel Hill, NC 27514
- Hope Pharmaceuticals; 16416 N. 92nd Street Suite 125; Scottsdale, AZ 85260
Sodium thiosulfate adverse (side) effects
Frequency not defined
Hypotension (infusion rate-dependent)
Nausea/vomiting
Disorientation
Headache
Prolonged bleeding therapy
Hypersensitivity reactions
Contact dermatitis
Warmth
Local irritation
Pregnancy and lactation
Pregnancy category: C
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Sodium thiosulfate
Mechanism of action
Thiosulfate is sulfur donor utilized by rhodenase to convert cyanide to less toxic thiocyanate
Cisplatin toxicity: Na-thiosulfate combines w/ cisplatin to form a complex nontoxic to both normal/cancerous cells
Increases solubility of calcium
Pharmacokinetics
Half-life: 3 hr (thiosulfate); 3 days (thiocyanate); 9 days (renal impairment)
Excretion: Urine (20-50%)
