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Poisoning Information for the Public & Health Care Professionals
Last updated: 07/2015
Antidote
Adult

Hydroxocobalamin

Cyanokit®

Print Monograph
Antidote
Adult

Hydroxocobalamin

Cyanokit®

Indications

  • Cyanide poisoning from hydrogen cyanide gas (smoke inhalation), ingestion of cyanide salts, high dose nitroprusside infusions.
  • May be used alone or in combination with sodium thiosulfate.

Dosage

  • Initial dose: 5 g IV over 15 minutes.
  • Depending on severity of poisoning and clinical response, the same dose may be repeated once. The rate of infusion for the second dose may range from 15 minutes to 2 hours as clinically indicated.
  • Doses up to 20 g have been used in severe poisoning.

Administration

  • Reconstitution: For a final concentration of 25 mg/mL: reconstitute each 2.5 g vial with 100 mL sodium chloride 0.9% or reconstitute each 5 g vial with 200 mL sodium chloride 0.9%. Use the transfer spike provided. Rock or invert the vial for at least 1 minute to mix. Do not shake.
  • Infusion: Infuse the reconstituted 5 g dose over 15 minutes. Use administration set provided as it contains the appropriate filter. The provided administration set can be piggybacked into a primary line. Blood pressure monitoring is required.

Compatibility, Stability

  • Compatible with sodium chloride 0.9% (recommended), dextrose 5% in water and lactated ringer’s.
  • Do not administer other drugs, especially sodium thiosulfate, in the same line as hydroxocobalamin.
  • Once reconstituted, the vial is stable for 6 hours at room temperature.
  • Reconstituted solution should be dark red in colour.
  • Protect vials from light.

Potential Hazards of Administration

  • Hypertension (transient; returns to baseline within 4 hours of dose).
  • Nausea, headache, dizziness.
  • Red discolouration of the urine (pronounced for 3 days following dose; may last up to 5 weeks).
  • Erythema of skin or mucous membranes (may last up to 2 weeks), pustular rash mainly affecting the face and neck  (usually 7 - 28 days following treatment).
  • Allergic reactions (including anaphylaxis, chest tightness, edema, urticaria, pruritus, dyspnea, rash.

Miscellaneous

  • Hydroxocobalamin may interfere with some clinical chemistry assays such as:

    - aminotransferases, bilirubin, creatinine, creatine kinase, phosphorus, magnesium, lactate

    - Co-oximetry readings such as carboxyhemoglobin, methemoglobin, which may be of significant clinical consequence in the setting of smoke inhalation

  • Hydroxocobalamin may trigger blood leak alarms on certain hemodialysis machines, likely due to colorimetric interference.


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