Sodium Nitrite Dosage

Usual Adult Dose for Cyanide Poisoning

Sodium Nitrite: 300 mg (10 mL) at a rate of 2.5 to 5 mL/minute
Sodium Thiosulfate: 50 mL immediately following sodium nitrite administration

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

Comments:

• Use with caution if the diagnosis of cyanide poisoning is uncertain.
• If clinical suspicion of cyanide poisoning is high, administer without delay and in conjunction with appropriate airway, ventilatory, and circulatory support.
• Expert advice from a regional poison control center may be obtained by calling 1-800-222-1222.

Use(s): For sequential use with sodium thiosulfate for acute cyanide poisoning that is judged to be serious or life-threatening.

Usual Pediatric Dose for Cyanide Poisoning

Sodium Nitrite: 0.2 mL/kg (6 mg/kg or 6 to 8 mL/m2 BSA) at a rate of 2.5 to 5 mL/minute
Maximum dose: 300 mg (10 mL)
Sodium Thiosulfate: 1 mL/kg (250 mg/kg or approximately 30 to 40 mL/m2 BSA), not to exceed 50 mL total dose, immediately following sodium nitrite administration

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

Comments:

• Use with caution if the diagnosis of cyanide poisoning is uncertain.
• If clinical suspicion of cyanide poisoning is high, administer without delay and in conjunction with appropriate airway, ventilatory, and circulatory support.
• Expert advice from a regional poison control center may be obtained by calling 1-800-222-1222.
• Use with caution in patients under 6 months old; the presence of fetal hemoglobin, which is oxidized to methemoglobin more easily than adult hemoglobin, along with lower methemoglobin reductase levels compared to older patients, makes these patients at higher risk of developing severe methemoglobinemia compared to older patients.
• Mortality attributed to sodium nitrite was reported in a 17 month old child after administration of an adult dose (300 mg IV followed by a second dose of 150 mg).

Use(s): For sequential use with sodium thiosulfate for acute cyanide poisoning that is judged to be serious or life-threatening.

Renal Dose Adjustments

Use with caution.

• This drug is substantially excreted by the kidney.
• The risk of toxic reactions may be greater in impaired renal function.
• Because elderly patients are more likely to have decreased renal function, use care in dose selection and monitor renal function.

Liver Dose Adjustments

Data not available.

Precautions

US BOXED WARNING(S):
LIFE THREATENING HYPOTENSION AND METHEMOGLOBIN FORMATION

• Sodium nitrite can cause serious adverse events and death, even at doses less than twice the recommended therapeutic dose.
• Sodium nitrite causes hypotension and methemoglobin formation, which diminished oxygen carrying capacity.
• Hypotension and methemoglobin formation can occur concomitantly or separately.
• Because of these risks, use this product for life-threatening cyanide poisoning; use with caution if the diagnosis of cyanide poisoning is uncertain.
• Closely monitor patients during treatment to ensure adequate perfusion and oxygenation.
• Consider alternative therapeutic approaches in patients with known diminished oxygen or cardiovascular reserve (e.g. smoke inhalation victims, pre-existing 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 of life-threatening adverse events with this drug.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available.

Other Comments

IV compatibility:

• This drug is incompatible with hydroxocobalamin; do not administer via the same intravenous line.

Monitoring:

• Blood pressure must be monitored during treatment.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer