sodium nitrite and sodium thiosulfate

Generic Name: sodium nitrite and sodium thiosulfate (SOO dee um NYE trite and SOO de um THYE oh SUL fate)
Brand Name: Nithiodote

What is sodium nitrite and sodium thiosulfate?

Sodium nitrite and sodium thiosulfate is a combination medicine that is used as an antidote to cyanide poisoning. Sodium nitrite and sodium thiosulfate works by helping cells in the body convert cyanide to a form that can be removed from the body through urination.

Sodium nitrite and sodium thiosulfate is used in an emergency to treat cyanide poisoning. This type of poisoning can occur if you are exposed to smoke from a house or industrial fire, if you swallow or breathe in cyanide, or if you get cyanide on your skin.

Sodium nitrite and sodium thiosulfate may also be used for purposes not listed in this medication guide.

What is the most important information I should know about sodium nitrite and sodium thiosulfate?

If possible before you receive sodium nitrite and sodium thiosulfate, tell your caregivers if you have anemia, low blood pressure, or heart disease.

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In an emergency situation it may not be possible before you are treated to tell your caregivers about your health conditions or if you are pregnant or breast feeding. Make sure any doctor caring for you afterward knows that you have received this medication.

What should I discuss with my healthcare provider before receiving sodium nitrite and sodium thiosulfate?

If possible before you receive sodium nitrite and sodium thiosulfate, tell your caregivers if you have:

  • anemia (low red blood cells);

  • a genetic enzyme deficiency called glucose-6-phosphate dehydrogenase (G6PD) deficiency;

  • low blood pressure; or

  • heart disease.

FDA pregnancy category C. Tell your doctor if you are pregnant. It is not known whether sodium nitrite and sodium thiosulfate will harm an unborn baby. However, the benefits of treating cyanide poisoning may outweigh any risks posed by this medication, for both you and your baby.

It is not known whether this medication passes into breast milk or if it could harm a nursing baby. You should not breast-feed shortly after you have been treated with sodium nitrite and sodium thiosulfate. Ask your doctor how long you should wait before breast-feeding again. If you use a breast pump during this time, throw out any milk you collect. Do not feed it to your baby.

In an emergency situation, it may not be possible before you are treated with sodium nitrite and sodium thiosulfate to tell your caregivers if you are pregnant or breast feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medication.

How is sodium nitrite and sodium thiosulfate given?

This medication is injected into a vein through an IV. You will receive this injection in a clinic or emergency setting.

Sodium nitrite and sodium thiosulfate are given as two separate injections.

Your breathing, blood pressure, oxygen levels, heart function, and other vital signs will be watched closely while you are receiving sodium nitrite and sodium thiosulfate.

What happens if I miss a dose?

Since sodium nitrite and sodium thiosulfate is given by a healthcare professional in an emergency setting, you are not likely to miss a dose.

What happens if I overdose?

Since this medication is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

What should I avoid after receiving sodium nitrite and sodium thiosulfate?

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Sodium nitrite and sodium thiosulfate side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; chest tightness, difficulty breathing; swelling of your face, lips, tongue, or throat.

Tell your caregivers right away if you have a serious side effect such as:

  • feeling like you might pass out;

  • headache, tired feeling, blue-colored skin, feeling short of breath;

  • fast or irregular heart rate; or

  • pounding heartbeats or fluttering in your chest.

Less serious side effects may include:

  • mild dizziness;

  • blurred vision;

  • confusion, anxiety, sweating;

  • nausea, vomiting, stomach pain;

  • salty taste in your mouth;

  • feeling of warmth; or

  • tingly feeling where the injection was given.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Sodium nitrite and sodium thiosulfate dosing information

Usual Adult Dose for Cyanide Poisoning:

Sodium Nitrite -10 mL of 300 mg/10 mL at the rate of 2.5 to 5 mL/minute by intravenous infusion
Sodium Thiosulfate - 50 mL of 12.5 grams/50 mL by intravenous infusion immediately following administration of sodium nitrite.

If signs of cyanide poisoning reappear, repeat treatment using one-half the original dose of both sodium nitrite and sodium thiosulfate.

Usual Pediatric Dose for Cyanide Poisoning:

Sodium Nitrite - 0.2 mL/kg (6 mg/kg or 6-8 mL/m2 BSA) of sodium nitrite at the rate of 2.5 to 5 mL/minute not to exceed 10 mL by intravenous infusion
Sodium Thiosulfate - 1 mL/kg of body weight (250 mg/kg or approximately 30-40 mL/m2 of BSA) not to exceed 50 mL total dose by intravenous infusion immediately following administration of sodium nitrite.


Redosing: If signs of cyanide poisoning reappear, repeat treatment using one-half the original dose of both sodium nitrite and sodium thiosulfate.

What other drugs will affect sodium nitrite and sodium thiosulfate?

If possible before you receive this medication, tell your doctor about all other medicines you use, especially:

  • blood pressure medication;

  • a diuretic (water pill); or

  • sildenafil (Viagra), tadalafil (Cialis), and other erectile dysfunction medicines.

There may be other drugs that can interact with sodium nitrite and sodium thiosulfate. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about sodium nitrite and sodium thiosulfate.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 1.02. Revision Date: 2013-12-03, 1:52:55 PM.

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