Nithiodote Sodium Thiosulfate and Sodium Nitrite

Sodium thiosulfate and sodium nitrite are used to treat cyanide poisoning.

Sodium thiosulfate and sodium nitrite are available under the following different brand names: Nithiodote.

Dosing Form and Strengths

Kit

• sodium thiosulfate injection: 250mg/mL (12.5g/50mL vial) 1 vial
• sodium nitrite injection: 30mg/mL (300mg/10mL vial) 1 vial

Dosage Considerations – Should be Given as Follows:

Cyanide Poisoning

• Adult: Sodium nitrite: 300 mg (i.e., 10 mL) intravenously (IV) infused at rate of 2.5-5 mL/minute
• Pediatric: Sodium nitrite: 6 mg/kg (i.e., 0.2 mL/kg or 8 mL/m² BSA of 3% solution) IV infused at rate of 2.5-5 mL/minute; not to exceed 10 mL (300 mg)  
• Adult: Sodium thiosulfate: 12.5 g (50 mL of 25% solution) slow IV infusion (over 10 minutes) immediately following sodium nitrite administration; adjust infusion rate according to blood pressure
• Pediatric: Sodium thiosulfate: 250 mg/kg (ie, 1 mL/kg or 30-40 mL/m² BSA of 25% solution) slow IV infusion (over 10 minutes) immediately following sodium nitrite; adjust infusion rate according to blood pressure
• If signs of poisoning reappear, repeat treatment using one-half the original dose of both sodium nitrite and sodium thiosulfate
• Anemia: Reduce dose of sodium nitrite proportional to hemoglobin concentration

Renal Impairment

• Substantially excreted by the kidney; the risk of toxic reactions to these drugs may be greater in patients with impaired renal function

Hepatic Impairment

• Not studied

Side effects of sodium thiosulfate and sodium nitrite include:

Sodium nitrite

• Lightheadedness/fainting
• Low blood pressure (hypotension)
• Fast heart rate
• Palpitations
• Sweating
• Shortness of breath
• Abnormal heart rhythm
• Methemoglobinemia
• Headache
• Dizziness
• Rapid breathing
• Blurred vision
• Seizures
• Confusion
• Coma

Sodium thiosulfate

• Low blood pressure (hypotension)
• Headache
• Disorientation
• Nausea/vomiting
• Salty taste
• Prolonged bleeding time
• Warmth

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.