Sodium nitrite
Administration
- Type: Antidote
- Dosage Forms:
- Routes of Administration: IV
- Common Trade Names:
Adult Dosing
- Symptomatic cyanide toxicity: 300 mg of sodium nitrite (10 mL of 3% solution) IV over 3–5 minutes. If no response after 30min, give additional half-dose
Pediatric Dosing
Sodium nitrite (Pediatric Dosing)
| Hb Level (g/dL) | Dose of 3% sodium nitrite (mL/kg) |
| 7 | 0.19 |
| 8 | 0.22 |
| 9 | 0.25 |
| 10 | 0.27 |
| 11 | 0.30 |
| 12 | 0.33 |
| 13 | 0.36 |
| 14 | 0.39 |
- Max dose should not exceed 10mL
- Do not give faster than 5mL/min (to avoid hypotension)
Special Populations
- Pregnancy Rating: No assigned FDA category; may impair oxygen delivery to fetus
- Lactation risk:
- Renal dosing:
- Hepatic dosing:
Contraindications
- Allergy to class/drug
- Significant preexisting methemoglobinemia (>40%)
- Severe hypotension (relative)
- Concurrent carbon monoxide toxicity (relative)
Adverse Reactions
Serious
- Hypotension (especially with rapid IV push); may be exacerbated by alcohol and other vasodilatory agents
- Severe, potentially fatal, methemoglobinemia
- Tachycardia
Common
- Headache
- Facial flushing, dizziness, sweating
- Nausea, vomiting
Pharmacology
- Half-life:
- Metabolism:
- Excretion:
Mechanism of Action
- Oxidizes hemoglobin to methemoglobin, which binds free cyanide. Vasodilation may also enhance endothelial cyanide detoxification