Generic
Sodium Thiosulfate
4 brands available in the market
At a glance
Sodium Thiosulfate is indicated for sequential use with sodium nitrite for the treatment of acute cyanide poisoning that is judged to be life-threatening. It acts as a sulfur-donating substrate for the enzyme rhodanese, converting cyanide to the less toxic thiocyanate.
Description
Sodium Thiosulfate acts as an antidote in cyanide poisoning. It serves as a sulfur donor for the enzyme rhodanese, speeding up the conversion of cyanide to thiocyanate, which is relatively non-toxic and easily excreted in urine. It is used in combination with sodium nitrite but may be used alone in less severe poisoning.
Indications
- Acute cyanide poisoning (sequential use with sodium nitrite)
- Calcium urolithiasis
- Secondary preventive treatment for calciphylaxis in dialysis patients
Therapeutic class
Antidote Preparations
Pharmacological class
Cyanide Antidote
Pharmacology
Sodium Thiosulfate acts as a sulfur donor for the enzyme rhodanese, which converts cyanide to thiocyanate. Thiocyanate is relatively non-toxic and easily eliminated in urine. It also reduces cisplatin toxicity by forming a complex with cisplatin and increases calcium solubility.
Mechanism of action
Converts cyanide to less toxic thiocyanate.
Dosage
Adult (Cyanide Poisoning):
- After sodium nitrite 300 mg (over 5-20 min): 12.5 g sodium thiosulfate (50 ml of 25% or 25 ml of 50% solution) over 10 min
- If symptoms recur: Repeat at half doses after 30 min
Pediatric (Cyanide Poisoning):
- After sodium nitrite 4-10 mg/kg (max 300 mg): 400 mg/kg sodium thiosulfate (25-50% solution; max 12.5 g)
- If symptoms recur: Repeat at half doses after 30 min
Administration
- Administered intravenously (cyanide poisoning)
- Oral: Daily or 3 times weekly (for calcium urolithiasis/calciphylaxis)
Missed dose
If you miss a dose, consult your doctor.
Side effects
Side Effects:
- Osmotic disturbances
- Oral: Catharsis (diarrhea) at high doses
- Irritation to eyes, skin, and respiratory tract
Precautions & warnings
- Caution in edematous sodium-retaining conditions
- Caution in pregnancy and lactation
- Monitor renal function (especially in elderly)
- Caution in sulfite-sensitive patients
Contraindications
- Edematous sodium-retaining conditions
Drug interactions
- Cisplatin: Decreases cisplatin toxicity through rapid chemical inactivation of its platinum component
Food interactions
Caution is advised when consuming alcohol with Sodium Thiosulfate; consult your doctor.
Use in pregnancy
Use in Pregnancy: No adequate controlled studies; use in life-threatening situations only if needed; consult your doctor.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Unknown if excreted in human milk; breastfeeding is not a contraindication in life-threatening situations; caution required; consult your doctor.
Pediatric use
No clinical studies to evaluate safety or efficacy in pediatric population; case reports in medical literature exist
Geriatric use
Excreted by the kidney; elderly patients are more likely to have decreased renal function; caution required
Renal / hepatic impairment
Renal Impairment: Caution required; dose adjustment may be needed; consult your doctor.
Hepatic Impairment: Caution required; consult your doctor.
Overdose effects
Limited information on large doses in humans; oral 3 g/day for 1-2 weeks reduced oxygen saturation to 75% (rightward shift of oxygen-hemoglobin dissociation curve); IV 20 mL of 10% did not change oxygen saturation.
Storage conditions
Store at controlled room temperature 20-25°C; protect from direct light; do not freeze.
Chemical structure
Sodium Thiosulfate