Sodium thiosulfate
thiosulfate
What it isSulfur donor for rhodanese; cyanide poisoning and cisplatin ototoxicity prevention.
Why this oneIt provides the sulfur that converts cyanide to thiocyanate, and it reduces hearing loss in children given cisplatin.
What limits itSlow onset limits it as sole cyanide therapy. Thiocyanate accumulates in renal failure.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Cyanide poisoning (after sodium nitrite) | Adults | 50 mL (12.5 g) IV once | — | 50 mL |
| Cyanide poisoning (after sodium nitrite) | Children | 1 mL/kg (250 mg/kg; ~30–40 mL/m² BSA) IV once | — | 50 mL total |
Renal Substantially renally excreted; greater risk of toxic reactions in renal impairment
Hepatic Undefined
If signs of cyanide poisoning reappear, repeat at one-half the original dose
Instructions
- Administer IV immediately following sodium nitrite
- Do not administer via the same IV line as hydroxocobalamin (chemically incompatible)
- Monitor blood pressure during treatment
- Do not delay airway, ventilatory, and circulatory support
Available strengths
- inj 250 mg/mL
Cautions
- May contain trace impurities of sodium sulfite (relevant to sulfite-sensitive patients)
- Hypotension
Adverse reactions
- Hypotension
- Headache
- Disorientation
- Nausea
- Vomiting
- Prolonged bleeding time
- Salty taste
- Warm sensation over body
Pregnancy No human data; do not withhold life-sustaining therapy for cyanide poisoning during pregnancy
Lactation Breastfeeding not recommended during treatment
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 250 mg/mL | inj | per unit | not offered |
NO BOXED WARNINGS
Principal riskSlow onset limits it as sole cyanide therapy
Classes and tags
Clinical profile
Defining liabilityInfusion hypotension and gastrointestinal intolerance