Sodium Thiosulfate Antidote is indicated for the treatment of known or suspected cyanide poisoning.

Cyanide Toxicity

• First dose: 50 mL (12.5 g) of sodium thiosulfate should be injected intravenously right after 10 mL (300 mg) of sodium nitrite (at a rate of 2.5 to 5 mL/minute).
• As an alternative, infuse 50 mL (12.5 g) of sodium thiosulfate at a rate of 5 mL/minute after the initial dose of 5 g hydroxocobalamin, which was given as an intravenous infusion during a 15-minute period.
• In infants to adolescents (0 to 18 years old), 0.2 mL/kg (6 mg/kg or 6-8 mL/m² BSA) of sodium nitrite (rate of 2.5 to 5 mL/minute) not to exceed 10 mL should be administered intravenously, immediately followed by 1 mL/kg of body weight (250 mg/kg or approximately 30-40 mL/m² of BSA) (rate of 2.5 to 5 mL/minute) not to exceed 50 mL total dose of sodium thiosulfate.
• As an alternative, in children and adolescents (0 to 18 years old), the initial dose of hydroxocobalamin is 70 mg/kg body weight, not to exceed 5 g, followed by sodium thiosulfate at a total dose of no more than 1 mL/kg (250 mg/kg, or around 30-40 mL/m²), not to exceed 50 mL.

Common side effects of Sodium Thiosulfate Antidote include-

• nausea
• vomiting
• headache
• sensation of warmth 
• flushing

Vomiting

Headache

Warmth

Flushing

• Sodium Thiosulfate Antidote should be used with caution in patients with a history of allergic reactions to thiosulfate or any of the other ingredients in the formulation.
• It should also be used with caution in patients with liver or kidney disease, as thiosulfate is primarily excreted through the kidneys.
• Patients receiving Sodium Thiosulfate Antidote should be monitored for signs of anaphylaxis or other allergic reactions.