Active Ingredient: Thiosulfate
Sodium thiosulfate is indicated for sequential use with hydroxocobalamin or sodium nitrite for the treatment of acute cyanide poisoning that is judged to be life-threatening.
When the diagnosis of cyanide poisoning is uncertain, the potentially life-threatening risks associated with sodium thiosulfate should be carefully weighed against the potential benefits, especially if the patient is not in extremis.
Sodium thiosulfate is to be administered together with appropriate decontamination and supportive measures.
For this indication, competent medicine agencies globally authorize below treatments:
For:
Intravenous, 12.5 grams thiosulfate, one dose.
300 mg of sodium nitrite should be administered intravenously, immediately followed by 12.5 g of sodium thiosulfate.
Alternatively, an initial dose of 5 g hydroxocobalamin administered as an intravenous infusion over 15 minutes followed by 12.5 g of sodium thiosulfate.
NOTE: If no treatment response is observed within 30 to 60 minutes or if signs of poisoning reappear, repeat treatment after 30 minutes of initial administration using one-half the original dose of both sodium nitrite and sodium thiosulfate.
In patients with known anaemia, it is recommended that the dosage of sodium nitrite should be reduced proportionately to the hemoglobin concentration.
Administered by slow intravenous injection.
Cyanide antidotes should be given as early as possible after a diagnosis of acute life-threatening cyanide poisoning has been established. Sodium thiosulfate may be administered soon after prior treatment with a fast-acting cyanide antidote such as sodium nitrite or hydroxocobalamin. Blood pressure must be monitored during infusion in both adults and children. The rate of infusion should be decreased if significant hypotension is noted.
For:
Intravenous, 250 milligrams thiosulfate per kilogram of body weight, one dose.
In infants to adolescents (0 to 18 years old), 6 mg/kg of sodium nitrite should be administered intravenously, immediately followed by 250 mg/kg of body weight.
Alternatively, in infants to adolescents (0 to 18 years old), the initial dose of hydroxocobalamin is 70 mg/kg body weight not exceeding 5 g followed by 250 mg/kg of body weight.
NOTE: If no treatment response is observed within 30 to 60 minutes or if signs of poisoning reappear, repeat treatment after 30 minutes of initial administration using one-half the original dose of both sodium nitrite and sodium thiosulfate.
In patients with known anaemia, it is recommended that the dosage of sodium nitrite should be reduced proportionately to the hemoglobin concentration.
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