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Nithiodote Generic Name & Formulations
Legal Class
General Description
Pharmacological Class
How Supplied
Carton—1 (10mL vial sodium nitrite + 50mL vial sodium thiosulfate)
Manufacturer
Generic Availability
NO
Mechanism of Action
Sodium Nitrite:
Sodium nitrite is thought to exert its therapeutic effect by reacting with hemoglobin to form methemoglobin, an oxidized form of hemoglobin incapable of oxygen transport but with high affinity for cyanide. Cyanide preferentially binds to methemoglobin over cytochrome a3, forming the nontoxic cyanomethemoglobin. Methemoglobin displaces cyanide from cytochrome oxidase, allowing resumption of aerobic metabolism.
Sodium Thiosulfate:
The primary route of endogenous cyanide detoxification is by enzymatic transulfuration to thiocyanate (SCN-), which is relatively nontoxic and readily excreted in the urine. Sodium thiosulfate is thought to serve as a sulfur donor in the reaction catalyzed by the enzyme rhodanese, thus enhancing the endogenous detoxification of cyanide.
Nithiodote Indications
Indications
Acute cyanide poisoning that is judged to be serious or life-threatening.
Nithiodote Dosage and Administration
Adult
Give by slow IV infusion. Initially 10mL of sodium nitrite at a rate of 2.5–5mL/min, followed immediately by 50mL of sodium thiosulfate. Repeat at ½ the original dose of both agents, if signs of poisoning reappear. Known anemia: reduce dose proportionately to Hgb concentration.
Children
Give by slow IV infusion. Initially 0.2mL/kg of sodium nitrite at a rate of 2.5–5mL/min (max 10mL), followed immediately by 1mL/kg of sodium thiosulfate (max 50mL). Repeat at ½ the original dose of both agents, if signs of poisoning reappear. Known anemia: reduce dose proportionately to Hgb concentration. <6mos: use with caution.
Nithiodote Contraindications
Not Applicable
Nithiodote Boxed Warnings
Boxed Warning
Life-threatening hypotension. Methemoglobin formation.
Nithiodote Warnings/Precautions
Warnings/Precautions
Risk for severe hypotension, methemoglobinemia. Known diminished oxygen or cardiovascular reserve (eg, smoke inhalation victims, pre-existing anemia, substantial blood loss, cardiac or respiratory compromise). Congenital methemoglobin reductase deficiency. Monitor for ≥24–48hrs post-infusion to ensure adequate perfusion and oxygenation, for recurrent signs/symptoms of cyanide toxicity, and for methemoglobin levels (using co-oximetry). Obtain hemoglobin/hematocrit at treatment initiation. Patients susceptible to injury from vasodilation and related hemodynamic sequelae. Monitor hemodynamics during and post-infusion; reduce infusion rates if hypotension occurs. Anemia. Smoke inhalation injury or carbon monoxide poisoning. G6PD deficiency; consider alternative therapy. Volume depletion. Renal impairment. Elderly: monitor renal function. Neonates/infants. Pregnancy. Nursing mothers: not recommended.
Nithiodote Pharmacokinetics
Elimination
Renal. Half-life: ~20 minutes (sodium thiosulfate).
Nithiodote Interactions
Interactions
Caution with concomitant other drugs that may cause methemoglobinemia (eg, procaine, nitroprusside). Caution with concomitant antihypertensives, diuretics, or drugs known to increase vascular nitric oxide (eg, PDE5 inhibitors).
Nithiodote Adverse Reactions
Adverse Reactions
Sodium nitrite: syncope, hypotension, tachycardia, palpitations, dysrhythmia, methemoglobinemia, headache, dizziness, blurred vision, seizures, confusion, coma. Sodium thiosulfate: hypotension, headache, disorientation.
Nithiodote Clinical Trials
See Literature
Nithiodote Note
Not Applicable
Nithiodote Patient Counseling
See Literature
