AHFS Class:

91:04.24 Cyanide antidotes

Generic Name

• Hydroxocobalamin

Hydroxocobalamin as an antidote for acute cyanide poisoning (BTG International) is available as a lyophilized powder in 250-mL single-dose vials containing 5 g of hydroxocobalamin with hydrochloric acid for pH adjustment.⁴⁰¹³ Vials are packaged in a kit containing a transfer spike and infusion set; diluent is not included.⁴⁰¹³ The vial should be reconstituted with 200 mL of an appropriate diluent to yield a solution containing hydroxocobalamin 25 mg/mL.⁴⁰¹³ Sodium chloride 0.9% is recommended; however, if it is not available, the manufacturer states that Ringer's injection, lactated or dextrose 5% may be used as the diluent.⁴⁰¹³ Following the addition of diluent, the vial should be repeatedly inverted or rocked for at least 60 seconds prior to use; do not shake.⁴⁰¹³

Hydroxocobalamin (as the acetate) as a vitamin B₁₂ preparation is available as a 1000-mcg/mL solution for intramuscular injection.⁴⁰¹⁴ Consult specific product labeling for information about hydroxocobalamin as a vitamin B₁₂ preparation for intramuscular injection.⁴⁰¹⁴

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.

pH

Reconstituted solution: 3.5 to 6.⁴⁰¹³

Trade Name(s)

Cyanokit

Hydroxocobalamin is administered by intravenous infusion over 15 minutes to 2 hours.⁴⁰¹³

Hydroxocobalamin is a dark red powder that forms a dark red solution upon reconstitution.⁴⁰¹³

Intact vials of the lyophilized powder should be stored at controlled room temperature.⁴⁰¹³ However, vials may be exposed to the temperature variations for the following periods: 15 days at 5 to 40°C, 15 days at -20 to 40°C (freeze-thaw cycles), or 4 days at 5 to 60°C (e.g., desert transport).⁴⁰¹³

Reconstituted solutions are stable for up to 6 hours at temperatures not exceeding 40°C.⁴⁰¹³ Do not freeze.⁴⁰¹³ Unused portions should be discarded after 6 hours.⁴⁰¹³

Y-Site Injection Compatibility (1:1 Mixture)

Additional Compatibility Information

Blood Products

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.⁴⁰¹³

For a list of references cited in the text of this monograph, search the monograph titled References.

ASHP^® Injectable Drug Information^TM. Selected Revisions September 12, 2024. © Copyright, 2024. American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.