Cyanide Antidote Kit Disease Interactions
There are 10 disease interactions with Cyanide Antidote Kit (amyl nitrite/sodium nitrite/sodium thiosulfate).
- AMI
- Anemia
- Hemodialysis
- Hypotension
- Intracranial pressure
- Methemoglobinemia/hypotension
- Hypertrophic cardiomyopathy
- Renal impairment
- Renal impairment
- Glaucoma
Nitrates/nitrites (applies to Cyanide Antidote Kit) AMI
Major Potential Hazard, High plausibility. Applicable conditions: Myocardial Infarction, Congestive Heart Failure
The benefits of organic nitrates and nitrites in patients with acute myocardial infarction (AMI) or congestive heart failure have not been established and its use is not recommended in these settings. If used, it should be accompanied by careful clinical and hemodynamic monitoring to avoid the hazards of systemic hypotension and tachycardia, which in AMI can exacerbate myocardial ischemia. In general, oral or long-acting formulations of these drugs should not be used in the early management of AMI because of the difficulty in precisely controlling and rapidly terminating their hemodynamic effects should adverse reactions occur. Sublingual and other immediate- onset nitrates or nitrites should typically be avoided in suspected AMI with marked bradycardia or tachycardia, and should be used with extreme caution, if at all, in patients with right ventricular or inferior wall infarction. Rarely, sublingual nitroglycerin has produced hypotension accompanied by paradoxical bradycardia in patients with AMI and especially right ventricular infarction. The latter group of patients are also particularly dependent on adequate right ventricular preload to maintain cardiac output and can experience profound hypotension with nitrate or nitrite administration due to reduction of right ventricular preload.
Nitrates/nitrites (applies to Cyanide Antidote Kit) anemia
Major Potential Hazard, High plausibility.
Some manufacturers and medical references consider the use of nitrates and nitrites to be contraindicated in patients with severe anemia. Nitrates and nitrites can cause methemoglobinemia, primarily in high-dose intravenous therapy or acute poisoning and in patients with NADH reductase deficiency. However, elevations of methemoglobin may also occur with commonly used dosages. While probably not of routine clinical significance, the increases may be important in certain patient populations such as those with coronary insufficiency or anemia.
Nitrates/nitrites (applies to Cyanide Antidote Kit) hemodialysis
Major Potential Hazard, High plausibility.
The combined effect of organic nitrates or nitrites with hemodialysis, which often lowers blood pressure, can cause life-threatening hypotension. Therapy with these agents should be administered cautiously in patients requiring hemodialysis. The medication should be withheld before undergoing dialysis, and hemodynamic stability should be established prior to resumption of medication following dialysis. Nitroglycerin and isosorbide dinitrate are moderately dialyzed.
Nitrates/nitrites (applies to Cyanide Antidote Kit) hypotension
Major Potential Hazard, High plausibility. Applicable conditions: Cerebrovascular Insufficiency, Dehydration, Shock, Constrictive Pericarditis, Aortic Stenosis
Organic nitrates and nitrites may cause severe hypotension, syncope and shock, even with small doses. Hypotension induced by these agents may be accompanied by paradoxical bradycardia and increased angina pectoris. Therapy with nitrates and nitrites should be administered cautiously in patients who are volume-depleted or hypotensive (e.g., systolic blood pressure <90 mm Hg) or who, because of inadequate circulation to the brain or to other vital organs, would be unusually compromised by undue hypotension. Patients should be in a sitting or recumbent position during and immediately after drug administration, and monitored for symptoms of severe hypotension such as nausea, vomiting, weakness, pallor, perspiration, and syncope. Nitrate or nitrite therapy is considered contraindicated in patients with acute circulatory failure or shock.
Nitrates/nitrites (applies to Cyanide Antidote Kit) intracranial pressure
Major Potential Hazard, High plausibility. Applicable conditions: Head Injury, Intracranial Hemorrhage, Intracranial Hypertension, Brain/Intracranial Tumor
Organic nitrates and nitrites can increase cerebrospinal fluid pressure. Therapy with these agents should be administered cautiously, if at all, in patients with or at risk for intracranial hypertension, including those with cerebral hemorrhage, intracranial lesions, or recent head trauma.
Sodium nitrite (applies to Cyanide Antidote Kit) methemoglobinemia/hypotension
Major Potential Hazard, High plausibility. Applicable conditions: G-6-PD Deficiency, Anemia, Pulmonary Impairment
Sodium nitrite causes hypotension and methemoglobin formation, which diminishes oxygen carrying capacity. Hypotension and methemoglobin formation can occur concurrently or separately. Sodium nitrite should be used to treat acute life-threatening cyanide poisoning but be used with caution in patients where the diagnosis of cyanide poisoning is uncertain. Patients should be closely monitored to ensure adequate perfusion and oxygenation during treatment with sodium nitrite. Alternative therapeutic approaches should be considered in patients known to have diminished oxygen or cardiovascular reserve (e.g., smoke inhalation victims, preexisting anemia, cardiac or respiratory compromise), and those at higher risk of developing methemoglobinemia (e.g., congenital methemoglobin reductase deficiency) as they are at greater risk for potentially life-threatening adverse events related to the use of sodium nitrite.
Nitrates/nitrites (applies to Cyanide Antidote Kit) hypertrophic cardiomyopathy
Moderate Potential Hazard, High plausibility.
Organic nitrates and nitrites may aggravate the angina associated with hypertrophic cardiomyopathy and should be administered cautiously in patients with this condition.
Sodium nitrite (applies to Cyanide Antidote Kit) renal impairment
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction
Sodium nitrite is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.
Sodium thiosulfate (applies to Cyanide Antidote Kit) renal impairment
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction
Sodium thiosulfate is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Care should be exercised when using this agent in patients with impaired renal function. Renal function should be monitored regularly in patients receiving therapy.
Nitrates/nitrites (applies to Cyanide Antidote Kit) glaucoma
Minor Potential Hazard, Low plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension
Some medical references state that organic nitrates and nitrites may increase intraocular pressure and should be used with caution in patients with glaucoma. However, the effect on intraocular pressure is variable and brief, and there is no evidence that these drugs precipitate narrow-angle glaucoma. Amyl nitrate typically may cause a slight rise of 3+ mm for several seconds followed by a fall in intraocular pressure for 10 to 20 minutes, the latter secondary to a fall in blood pressure. Nitroglycerin rarely produces ocular side effects, and oral nitroglycerin appears to have few to no significant ocular side effects.
Switch to professional interaction data
Cyanide Antidote Kit drug interactions
There are 325 drug interactions with Cyanide Antidote Kit (amyl nitrite/sodium nitrite/sodium thiosulfate).
Cyanide Antidote Kit alcohol/food interactions
There is 1 alcohol/food interaction with Cyanide Antidote Kit (amyl nitrite/sodium nitrite/sodium thiosulfate).
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
No interaction information available. |
Further information
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