Yes

Antidote

Parenteral: Used alone or with sodium nitrite or amyl nitrite in cyanide poisoning or arsenic poisoning; reduce the risk of nephrotoxicity associated with cisplatin therapy

Topical: Treatment of tinea versicolor

C

Hypersensitivity to any component

Safety in pregnancy has not been established; discontinue topical use if irritation or sensitivity occurs; rapid I.V. infusion has caused transient hypotension and EKG changes in dogs; can increase risk of thiocyanate intoxication

1% to 10%:

Central nervous system: Coma, CNS depression secondary to thiocyanate intoxication, psychosis, confusion

Dermatologic: Contact dermatitis, local irritation

Neuromuscular & skeletal: Weakness

Otic: Tinnitus

Cyanide toxicity: Increases the rate of detoxification of cyanide by the enzyme rhodanese by providing an extra sulfur

Cisplatin toxicity: Complexes with cisplatin to form a compound that is nontoxic to either normal or cancerous cells

Half-life: 0.65 hour

Elimination: 28.5% excreted unchanged in urine

Cyanide and nitroprusside antidote: I.V.:

Children <25 kg: 50 mg/kg after receiving 4.5-10 mg/kg sodium nitrite; a half dose of each may be repeated if necessary

Children >25 kg and Adults: 12.5 g after 300 mg of sodium nitrite; a half dose of each may be repeated if necessary

Cyanide poisoning: I.V.: Dose should be based on determination as with nitrite, at rate of 2.5-5 mL/minute to maximum of 50 mL.

Variation of sodium nitrate and sodium thiosulfate dose, based on hemoglobin concentration*:

Hemoglobin 7 g/dL:

Initial dose sodium nitrate: 5.8 mg/kg; initial dose 3% sodium nitrate: 0.19 mL/kg; initial dose 25% sodium thiosulfate: 0.95 mL/kg

Hemoglobin 8 g/dL:

Initial dose sodium nitrate: 6.6 mg/kg; initial dose 3% sodium nitrate: 0.22 mL/kg; initial dose 25% sodium thiosulfate: 1.10 mL/kg

Hemoglobin 9 g/dL:

Initial dose sodium nitrate: 7.5 mg/kg; initial dose 3% sodium nitrate: 0.25 mL/kg; initial dose 25% sodium thiosulfate: 1.25 mL/kg

Hemoglobin 10 g/dL:

Initial dose sodium nitrate: 8.3 mg/kg; initial dose 3% sodium nitrate: 0.27 mL/kg; initial dose 25% sodium thiosulfate: 1.35 mL/kg

Hemoglobin 11 g/dL:

Initial dose sodium nitrate: 9.1 mg/kg; initial dose 3% sodium nitrate: 0.30 mL/kg; initial dose 25% sodium thiosulfate: 1.50 mL/kg

Hemoglobin 12 g/dL:

Initial dose sodium nitrate: 10.0 mg/kg; initial dose 3% sodium nitrate: 0.33 mL/kg; initial dose 25% sodium thiosulfate: 1.65 mL/kg

Hemoglobin 13 g/dL:

Initial dose sodium nitrate: 10.8 mg/kg; initial dose 3% sodium nitrate: 0.36 mL/kg; initial dose 25% sodium thiosulfate: 1.80 mL/kg

Hemoglobin 14 g/dL:

Initial dose sodium nitrate: 11.6 mg/kg; initial dose 3% sodium nitrate: 0.39 mL/kg; initial dose 25% sodium thiosulfate: 1.95 mL/kg

*Adapted from Berlin DM Jr, "The Treatment of Cyanide Poisoning in Children," Pediatrics, 1970, 46:793.

Cisplatin rescue should be given before or during cisplatin administration: I.V. infusion (in sterile water): 12 g/m² over 6 hours or 9 g/m² I.V. push followed by 1.2 g/m² continuous infusion for 6 hours

Arsenic poisoning: I.V.: 1 mL first day, 2 mL second day, 3 mL third day, 4 mL fourth day, 5 mL on alternate days thereafter

Children and Adults: Topical: 20% to 25% solution: Apply a thin layer to affected areas twice daily

I.V.: Inject slowly, over at least 10 minutes; rapid administration may cause hypotension

Monitor for signs of thiocyanate toxicity

No information available to require special precautions

No effects or complications reported

Avoid topical application near the eyes, mouth, or other mucous membranes; notify physician if condition worsens or burning or irritation occurs; shake well before using

Do not apply topically to or near eyes; inject I.V. slowly, over at least 10 minutes; rapid administration may cause hypotension

Monitor for signs of thiocyanate toxicity

Injection: 100 mg/mL (10 mL); 250 mg/mL (50 mL)

Lotion: 25% with salicylic acid 1% and isopropyl alcohol 10% (120 mL, 180 mL)

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Gandara DR, Wiebe VJ, Perez EA, et al, "Cisplatin Rescue Therapy: Experience With Sodium Thiosulfate, WR2721, and Diethyldithiocarbamate," Crit Rev Oncol Hematol, 1990, 10(4):353-65.

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