Sodium Nitrite and Sodium Thiosulfate

Sodium nitrite and sodium thiosulfate in combination are extensively used via injection in the treatment of cyanide poisoning.

Overview

Sodium thiosulfate and sodium nitrite in combination are used via injection to treat the effects of cyanide poisoning. Poisoning with cyanide is an extremely serious condition that can be fatal in many cases and as such always necessitates immediate attention.

Cyanide poisoning typically results from exposure to toxic compounds that contain cyanide. These chemicals can be contained in some materials that are used in the manufacturer of household furnishings. This is why cyanide poisoning occurs commonly in people who have inhaled smoke during a house fire. Certain insecticides are also known to contain cyanide, as do some metal polishes, and the seeds of some fruits such as cherries, apples, and apricots.

Cyanide in liquids can be absorbed through the skin. It can be ingested in food or inhaled in gaseous form via smoke. The toxin interferes with the body’s cellular respiration, which results in the tissues being unable to use the oxygen.

Sodium thiosulfate and sodium nitrite combination injection works by reacting with the hemoglobin that is contained in the patient’s blood to form methemoglobin. The methemoglobin acts like a magnet to the cyanide, binding with it and effectively preventing it from stripping oxygen from the red blood cells. In addition, sodium thiosulfate converts the cyanide molecules into thiocyanate, which is much less toxic to the body. The thiocyanate is more easily and readily excreted in the patient’s urine, speeding the removal of the toxin from the body.

In the US, the medication is sold under the brand name Nithiodote. The medication must only be given by or under the immediate supervision of a medical professional and comes in solution form.

Conditions Treated

  • Cyanide poisoning

Type of Medicine

  • Solution for intravenous injection

Side Effects

This medication can cause unwanted side effects in some people. Not all the side effects listed here will occur, but you may need medical attention if you do experience them.

Some patients who are treated with this medication may have a serious allergic reaction called anaphylaxis. If breathing difficulties, swelling of the throat, tongue, or lips occurs, call 911.

If you notice any of the following effects, you should tell your doctor or medical professional immediately:

  • Wheezing
  • Vomiting
  • Unusual tiredness or weakness
  • Unusual bleeding or bruising
  • Tightness in the chest
  • Sweating
  • Sore throat
  • Shortness of breath
  • Sensation of tingling or numbness
  • Seizures
  • Rapid heart rate
  • Pale skin
  • Nausea
  • Loss of consciousness
  • Labored or difficult breathing
  • Irregular heartbeat or pulse
  • Headache
  • Fever
  • Light-headedness when rising suddenly from a prone or seated position
  • Fainting
  • Drowsiness
  • Dizziness
  • Dark urine
  • Cyanosis
  • Confusion
  • Change in consciousness
  • Blurred vision

There are a number of side-effects listed below that do not require medical attention because they will resolve themselves as your body gets used to the drug. There may also be ways in which you can mitigate or manage any unwanted effects, and your treating physician will give you more information on this. If you have any further questions on your treatment with Nithiodote, ask your doctor or pharmacist.

  • Warm sensation all over the body
  • Tingling sensation at the site of your injection
  • Skin rash
  • Salty taste
  • Reddening of the skin
  • Itchiness
  • Increased sweating
  • Hives or welts
  • Headache
  • Confusion about identity, place, and time
  • Anxiety
  • Stomach or abdominal pain

You may have a small amount of local irritation or bruising around the needle site. These effects should disappear within a few days.

You may experience other strange or unusual effects that are not listed above when you have been treated with this medication. If you have any concerns, contact your doctor for advice.

Dosage

You will only be given this medication by a doctor or other trained health professional in a hospital or clinic.

The correct dosage of this medication will vary between patients, depending on the extent of and origin of cyanide poisoning. The patient’s age and body weight will also be taken into account when calculating the correct dose of this drug.

Nithiodote should be injected into a vein via a cannula or tube.

Cyanide poisoning is a very dangerous, life-threatening condition. Therefore, Nithiodote is routinely used in the treatment of children, the elderly, and pregnant women. However, it is very important not to use more than the recommended dose and to carefully monitor the patient during their course of treatment. If at all practical, the risks and benefits of using this medication should be discussed fully with the patient, before treatment is commenced.

Interactions

Some medications should not be used together, as this may change how the drugs work and could also increase the risk of serious side-effects. However, in some cases, it may be appropriate to use two or more different medications, even though an interaction may occur. In this case, your doctor may opt to change the dose of one of your prescriptions. Alternatively, your doctor may suggest some precautions that you can take to negate the effect of any interactions.

There are no listings of any drugs that cause serious interactions with Nithiodote. However, you should still tell your doctor if you are taking any other form of medication, including non-prescription medicines, vitamin pills, or herbal remedies.

Warnings

Although there are no studies to show any specific problems related to the treatment of geriatric people with this drug, elderly people are potentially more likely to suffer from kidney problems. For this reason, extra caution should be taken when using Nithiodote as part of their treatment regimen. Close monitoring will also be required in case of a build-up of Nithiodote in the patient’s system due to poor kidney function.

Some existing medical conditions or a history of them may affect the efficacy of this medication. Be sure to discuss your medical history in full before commencing treatment with Nithiodote.

Nithiodote should be used with caution in patients who have a history of:

  • Anemia
  • Carbon monoxide poisoning
  • Glucose-6-phosphate dehydrogenase (G6PD) deficiency
  • Heart disease
  • Breathing or lung diseases, including COPD and asthma
  • Injury caused by smoke inhalation

This drug can cause the side-effects of these conditions to become worse.

Nithiodote should not be used in patients with hypotension as it could make this condition worse.

The medication should be used with caution in patients with a history of kidney disease. The effects of the medication may be amplified due to a slower removal of the drug from the patient’s body.

You will need to attend your doctor regularly for check-ups while you are taking this drug. These visits allow your doctor to monitor your progress and also provide you with the opportunity to ask any questions that you may have. Part of this monitoring process may include blood tests. In addition, Nithiodote can cause severe hypotension in some patients. This condition is potentially life-threatening and requires immediate medical intervention. Your doctor will check your blood pressure regularly to ensure that your blood pressure remains stable.

Nithiodote can cause methemoglobinemia in newborn babies and infants. This is a very serious condition, and your doctor will keep a close eye on the levels of methemoglobin in your blood while you are receiving this treatment.

There is no evidence that infants are at risk from this medication through breastfeeding. However, you should discuss this with your doctor and weigh the potential benefits against the risks of taking this medication if you are breastfeeding.

Storage

You will receive treatment with Nithiodote while you are hospitalized or attending an outpatient clinic. You will not be given this drug for home use.

Summary

Sodium thiosulfate and sodium nitrite in combination are used via injection to treat the effects of cyanide poisoning. Poisoning with cyanide is an extremely serious and potentially life-threatening condition that always necessitates immediate attention.

Treatment for serious cyanide poisoning always takes place in the hospital and the medication is given by a medical professional or under a doctor’s direct supervision.

There are a number of serious side-effects that can occur, following treatment with this drug. In addition, there are some medical conditions that will affect how this medication works. You will, therefore, need to attend your doctor regularly for check-ups during and following your course of treatment with this drug. Be sure to mention to your doctor if you have ever suffered any side-effects or bad reactions from any prescription or over-the-counter drugs, vitamin supplements or herbal preparations. You must also be prepared to give your doctor your full medical history before your treatment with sodium thiosulfate and sodium nitrite injection commences.

 

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Last Reviewed:
January 30, 2018
Last Updated:
February 10, 2018
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