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Cyanide Antidotes


Nithiodote


Cyanide antidote kit

Sodium Nitrate and Sodium Thiosulfate 300 mg / 10 mL and 12.5 grams / 50 mL Injection 10 mL and 50 mL

Recommended Dosing Sodium nitrite injection and sodium thiosulfate injection are administered by slow intravenous injection. They should be given as early as possible after a diagnosis of acute serious or life-threatening cyanide poisoning has been established. Sodium nitrite should be administered first, followed immediately by sodium thiosulfate. Blood pressure must be monitored during infusion in both adults and children. The rate of infusion should be decreased if significant hypotension is noted.

Age Intravenous Dose of Sodium Nitrite and Sodium Thiosulfate
Adults
  1. Sodium Nitrite -10 mL of sodium nitrite at the rate of 2.5 to 5 mL/minute
  2. Sodium Thiosulfate - 50 mL of sodium thiosulfate immediately following administration of sodium nitrite.
Children
  1. Sodium Nitrite - 0.2 mL/kg (6 mg/kg or 6-8 mL/m2 BSA) of sodium nitrite at the rate of 2.5 to 5 mL/minute not to exceed 10 mL
  2. Sodium Thiosulfate - 1 mL/kg of body weight (250 mg/kg or approximately 30-40 mL/m2 of BSA) not to exceed 50 mL total dose immediately following administration of sodium nitrite.

NOTE: If signs of poisoning reappear, repeat treatment using one-half the original dose of both sodium nitrite and sodium thiosulfate.

In adult and pediatric patients with known anemia, it is recommended that the dosage of sodium nitrite should be reduced proportionately to the hemoglobin concentration. [see Warnings and Precautions (5.2)]

Visually inspect all parenteral drug products for particulate matter and discoloration prior to administration.

(Source: Nithiodote HIGHLIGHTS OF PRESCRIBING INFORMATION)



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Cyanokit® (Hydroxocobalamin)


Cyanokit
  • Each Cyanokit® carton (NDC 49502-550-2) consists of the following:
    • Two 250 mL glass vials, each containing lyophilized hydroxocobalamin for injection, 2.5 g
    • Two sterile transfer spikes
    • One sterile IV infusion set
    • One quick use reference guide
  • Diluent is not included
  • Antidote Administration
    1. The starting dose of Cyanokit for adults is 5 g, (two 2.5 g vials) administered by IV infusion over 15 minutes.
    2. Depending upon the severity of the poisoning and the clinical response, a second dose of 5 g may be administered by IV infusion for a total dose of 10 g.
    3. The rate of infusion for the second 5 g dose may range from 15 minutes (for patients in extremis) to 2 hours based on patient condition.
    4. The recommended diluent is 0.9% Sodium Chloride injection

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References

  1. FDA approved labels/package inserts of Cyanokit (DailyMed, NLM)