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Nithiodote
sodium nitrite and sodium thiosulfate
Black Box Warnings .
Life-Threatening Hypotension and Methemoglobin Formation
serious rxns and death may occur w/ sodium nitrite, even at doses less than twice recommended dose; hypotension and methemoglobinemia, which diminishes oxygen carrying capacity, may occur concurrently or separately; use only in acute life-threatening cyanide poisoning and w/ caution in pts w/ uncertain diagnosis; monitor closely during tx to ensure adequate perfusion and oxygenation; consider alternatives in pts w/ diminished oxygen or cardiovascular reserve (e.g., smoke inhalation victims, pre-existing anemia, cardiac or resp. compromise) and pts w/ incr. methemoglobinemia risk (e.g., congenital methemoglobin reductase deficiency)
Adult Dosing .
Dosage forms: convenience pack
Special Note
- [convenience pack components]
- Info: pack contains sodium nitrite 300 mg vial x1 and sodium thiosulfate 12.5 g vial x1
cyanide poisoning, acute life-threatening
- [sodium nitrite 300 mg IV x1, then sodium thiosulfate 12.5 g IV x1]
- Info: if s/sx recur, may repeat x1 at 50% dose for both drugs; consider D/C sodium nitrite if methemoglobin levels >30%
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: convenience pack
Special Note
- [convenience pack components]
- Info: pack contains sodium nitrite 300 mg vial x1 and sodium thiosulfate 12.5 g vial x1
cyanide poisoning, acute life-threatening
- [sodium nitrite 6 mg/kg/dose IV x1, then sodium thiosulfate 250 mg/kg/dose IV x1]
- Max: sodium nitrite 300 mg/dose; sodium thiosulfate 12.5 g/dose; Alt: sodium nitrite 180-240 mg/m^2/dose IV x1, then sodium thiosulfate 7.5-10 g/m^2/dose IV x1; Info: if s/sx recur, may repeat x1 at 50% dose for both drugs; consider D/C sodium nitrite if methemoglobin levels >30%
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined
hepatic dosing
- [not defined]