Sodium thiosulfate
Administration
- Type: Antidote
- Dosage Forms:
- Routes of Administration: IV
- Common Trade Names:
Adult Dosing
Cyanide toxicity
- Adult: 12.5 g IV (after giving sodium nitrite 300 mg)
Prophylaxis during nitroprusside infusion
- Add 10 mg sodium thiosulfate for each 1 mg of nitroprusside
Pediatric Dosing
Cyanide toxicity
- Pediatric: 400 mg/kg IV
- Per micromedex: 412.5 mg/kg or 7 g/m(2) administered at a rate of 0.625 to 1.25 g/min IV
Prophylaxis during nitroprusside infusion
- Add 10 mg sodium thiosulfate for each 1 mg of nitroprusside
Special Populations
- Pregnancy Rating: C
- Lactation risk: Infant risk cannot be ruled out
- Renal dosing: not established
- Hepatic dosing: not established
Indications
- Acute cyanide toxicity
- Smoke inhalation with potential for cyanide exposure
- Prophylaxis during nitroprusside infusions
Contraindications
- Allergy to class/drug
Adverse Reactions
Serious
Common
- Burning sensation and muscle cramping from infusion
Pharmacology
- Half-life: 80 min
- Metabolism: Liver
- Excretion: Renal
Mechanism of Action
- Sulfur donor that promotes conversion of cyanide to thiocyanate
Comments
- Whereas the nitrites have adverse effects (induction of methemoglobinemia), sodium thiosulfate is non-toxic
- Should avoid nitrites in cyanide toxicity when CO poisoning is suspected to avoid lowering oxygen-carrying capacity
Indications by Condition
The following table is automatically generated from disease/condition pages across WikEM.
| Indication | Dose | Context | Route | Population |
|---|---|---|---|---|
| Cyanide toxicity | 12.5 g (1.65 mL/kg of 25%) | Sulfur donor for cyanide elimination | IV over 10 min | Adult |
See Also
References
- Olson, K. Poisoning and Drug Overdose, 1999.