Sodium thiosulfate as an antidote for acute cyanide poisoning (Hope Pharmaceuticals) is available as a 250-mg/mL (25%) solution in 50-mL single-dose vials containing 12.5 g of sodium thiosulfate.3092 The vials are available alone or packaged with sodium nitrite injection as a kit (Nithiodote).3092; 3093 Each mL of solution contains sodium thiosulfate 250 mg, boric acid 2.8 mg, and potassium chloride 4.4 mg with boric acid and/or sodium hydroxide for pH adjustment.3092; 3093 The drug also may contain trace impurities of sodium sulfite.3092; 3093
Sodium thiosulfate as a protective agent (Pedmark, Fennec Pharmaceuticals) is available as a 125-mg/mL solution in 100-mL single-dose vials.4012 Each mL contains the equivalent of 125 mg of sodium thiosulfate pentahydrate (equivalent to sodium thiosulfate anhydrous 80 mg) and boric acid 0.25 mg.4012 Sodium hydroxide and hydrochloric acid may have been added for pH adjustment.4012 Sodium sulfite may be present.4012
CAUTION: Care should be taken to ensure that the correct drug product, dose, and administration procedures are used and that no confusion with other products occurs.
Sodium thiosulfate products are not substitutable/interchangeable.4012
pH
250-mg/mL solution (Hope Pharmaceuticals): 7.5 to 9.3092; 3093
125-mg/mL solution (Pedmark, Fennec Pharmaceuticals): 6.5 to 8.4012
Trade Name(s)
Nithiodote, Pedmark
Sodium thiosulfate 250 mg/mL as an antidote (Hope Pharmaceuticals) is administered by slow intravenous injection.3092; 3093
Sodium thiosulfate 125 mg/mL as a protective agent (Pedmark, Fennec Pharmaceuticals) is administered by intravenous infusion over 15 minutes.4012 The appropriate dose should be withdrawn into a syringe or transferred into an empty infusion bag.4012
Sodium thiosulfate 250 mg/mL (Hope Pharmaceuticals): Intact vials should be stored at controlled room temperature and protected from direct light and freezing.3092; 3093 The injection solution is a clear solution.3092 Unused portions should be discarded.3092; 3093
Sodium thiosulfate 125 mg/mL (Pedmark, Fennec Pharmaceuticals): Intact vials should be stored at controlled room temperature.4012 The injection solution is a clear, colorless solution.4012 The prepared dose, if not used immediately, may be stored in an infusion bag at 20 to 22°C for no more than 18 hours.4012 Unused portions should be discarded.4012
Sorption
Sodium thiosulfate 125 mg/mL (Pedmark, Fennec Pharmaceuticals): The manufacturer states no incompatibilities have been observed between the injection solution and infusion bags made of polyvinyl chloride, ethylene vinyl acetate, or polyolefin.4012
Y-Site Injection Compatibility (1:1 Mixture)
Additional Compatibility Information
Other Cyanide Antidotes
Sodium thiosulfate 250 mg/mL (Hope Pharmaceuticals): If cyanide antidotes other than sodium nitrite are to be administered to patients receiving sodium thiosulfate, the manufacturer recommends that the drugs not be administered concurrently into the same intravenous infusion line.3092
Blood Products
Sodium thiosulfate 250 mg/mL (Hope Pharmaceuticals): The manufacturer states that simultaneous administration with blood products (e.g., whole blood, packed red cells, platelet concentrate and/or fresh frozen plasma) through the same intravenous line is not recommended.3092
For a list of references cited in the text of this monograph, search the monograph titled References.