Generic Name:

Hydroxocobalamin

Trade Name:

Cyanokit

Action:

Hydroxocobalamin binds to cyanide forming cyanocobalamin and is excreted in the urine

Indications:

Treatment of known or suspected cyanide poisoning

Administration Guidelines:

Diluent is not included in the kit; each 2.5g vial is reconstituted with 100mL of 0.9% NaCl

Usual Dosage Range and Route:

DOSE (IV) :

•  Initial : 70mg/kg (maximum dose: 5g) IV infusion over 15 minutes

•  Give second dose (70mg/kg, max: 5g) based on severity of poisoning and clinical response; infuse over 15 minutes to 2 hours, as clinically indicated

•  Maximum Total Dose : 10 g

Special Considerations:

• Use only if solution is dark red.
• Stable for 6 hours at room temperature.
• Collection of pretreatment blood cyanide concentrations should not delay administration in the emergent situation of suspected or known cyanide toxicity.
• Monitoring parameters: blood pressure and heart rate during and after infusion, serum lactate levels, and venous-arterial PO 2 gradient.
• Pretreatment levels of blood cyanide concentration, serum lactate levels, and venous-arterial PO 2 gradient may be useful as post-infusion levels may be inaccurate.
• Due to observed physical incompatibilities (particulate formation), the following medications should not be administered simultaneously through the same line as hydroxocobalamin.

• Diazepam ? Nitroglycerin
• Dobutamine ? Pentobarbital
• Dopamine ? Propofol
• Fentanyl ? Thiopental

• Due to observed chemical incompatibilities, the following medications should not be administered simultaneously through the same line as hydroxocobalamin.

• Sodium thiosulfate ? Ascorbic acid
• Sodium nitrate

Precautions and Side Effects:

• Elevations in blood pressure
• Headache
• Transient red coloration of urine (may last up to 5 weeks)
• Transient red coloration of skin and mucous membrane (may last up to 2 weeks)
• Acne-like rash
• May cause a false elevation of levels with automated colorimetric measures of AST, total bilirubin, creatinine, magnesium, and iron; it should not cause any clinical effects, but treating clinicians should be aware that the labs (especially total bilirubin) may be artificially elevated