Cyanide Poisoning: Life or Death?
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Nithiodote Nithiodote
Sodium Nitrite Injection, USP 300 mg/10 mL and
Sodium Thiosulfate Injection, USP 12.5 grams/50 mL

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NITHIODOTE is indicated for the treatment of acute cyanide poisoning that is judged to be life-threatening. When the diagnosis of cyanide poisoning is uncertain, the potentially life-threatening risks associated with NITHIODOTE should be carefully weighed against the potential benefits, especially if the patient is not in extremis.


Sodium nitrite can cause serious adverse reactions and death in humans, even at doses less than twice the recommended therapeutic dose. Sodium nitrite causes hypotension and methemoglobin formation, which diminishes oxygen carrying capacity. Hypotension and methemoglobin formation can occur concurrently or separately. Because of these risks, sodium nitrite should be used to treat acute life-threatening cyanide poisoning and be used with caution in patients where the diagnosis of cyanide poisoning is uncertain. Patients should be closely monitored to ensure adequate perfusion and oxygenation during treatment with sodium nitrite.

Alternative therapeutic approaches should be considered in patients known to have diminished oxygen or cardiovascular reserve (e.g. smoke inhalation victims, pre-existing anemia, cardiac or respiratory compromise), and those at higher risk of developing methemoglobinemia (e.g., congenital methemoglobin reductase deficiency) as they are at greater risk for potentially life-threatening adverse events related to the use of sodium nitrite.

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  • None.
  • Methemoglobinemia: Sodium nitrite reacts with hemoglobin to form methemoglobin and should be used with caution in patients known to have anemia. Monitor oxyhemoglobin and methemoglobin levels by pulse oximetry or other measurements. Optimally, the sodium nitrite dose should be reduced in proportion to the oxygen carrying capacity.
  • Smoke inhalation: Carbon monoxide contained in smoke can result in the formation of carboxyhemoglobin that can reduce the oxygen carrying capacity of the blood. Sodium nitrite should be used with caution in patients with smoke inhalation injury because of the potential for worsening hypoxia due to methemoglobin formation. Carboxyhemoglobin and oxyhemoglobin levels should be monitored by pulse oximetry or other measurements in patients that present with evidence of smoke inhalation. Optimally, the sodium nitrite dose should be reduced in proportion to the oxygen carrying capacity.
Most common adverse reactions are:
  • Sodium nitrite: syncope, hypotension, tachycardia, palpitations, dysrhythmia, methemoglobinemia, headache, dizziness, blurred vision, seizures, confusion, coma
  • Sodium thiosulfate: hypotension, headache, disorientation
  • Renal impairment: Sodium nitrite and sodium thiosulfate are substantially excreted by the kidney. The risk of toxic reactions to these drugs may be greater in patients with impaired renal function.

This website is intended for informational purposes only and not intended to replace discussion with a healthcare provider. The content of this website is not and should not be construed as medical advice. If you have questions about a particular medical issue, you should contact a healthcare provider. The expert advice of a regional poison control center may be obtained by calling 1-800-222-1222.

This website is intended for residents of the United States of America (USA) only and is subject to applicable U.S. laws and regulations.

If you have any questions regarding the content of this website, please contact Hope Pharmaceuticals.

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