Alternate Name(s):
CYANOKIT
Classification:
Antidote, Cyanide
Original Date:
March 2011
Revised Date:
March 2015
Indications:
- Treatment of cyanide poisoning
Reconstitution and Stability:
- Each vial contains 5 g dark red crystalline powder
- Stable at room temperature; protect from light
- May be exposed at short intervals to temperatures outside of room temperature (15 - 30C)
- Reconstitute 5 g vial with 200 mL 0.9% NaCl to get 25 mg/mL -using the supplied sterile transfer device . May use ringer's lactate or D5W if 0.9% NaCl not available
- Rock or invert vial for 60 seconds to mix the solution. DO NOT SHAKE
- Reconstituted vial stable for 6 hours at temperature between 2 - 40C
Compatibility:
- Solutions Compatible: 0.9% NaCl, ringer's lactate, D5W
-Incompatible: diazepam, dobutamine, dopamine , fentanyl, nitroglycerin, pentobarbital, propofol, thiopental, sodium thiosulfate, sodium nitrate, and ascorbic acid
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| IV Direct | NO |
| IV Intermittent Infusion | YES -use the infusion set provided in kit -includes appropriate filter Usual dilution: 25 mg/mL Infusion time: first dose -over 15 minutes If second dose needed - over 15 minutes - 2 hours depending upon the patient's clinical status |
| IV Continuous Infusion | NO |
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Pediatric:
- 70 mg/kg as a single infusion (maximum dose 5 g)
- May repeat a second dose of 70 mg/kg (maximun dose 5 g)
Adult:
- 5 g as a single infusion
- May repeat a second dose of 5 g depending on the severity of poisoning and clinical response (maximum cumulative dose 10 g)
Potential hazards of parenteral administration:
- Cardiovascular: Hypertension (18% to 28%), chest discomfort, tachycardia, bradycardia, hot flashes, periperal edema, angioneurotic edema
- Central nervous system: Headache, dizziness, memory impairment , restlessness
- Dermatologic; Erythema (94% to 100%; may last up to 2 weeks), rash (predominantly acneiform; 20% to 44%), can appear 7 - 28 days after administration and usually resolves within a few weeks)
- Gastrointestinal: Nausea, abdominal discomfort, diarrhea, dyspepsia, dysphagia, hematochezia, vomiting
- Genitourinry: Chromaturia (100%; may last up to 5 weeks after administration)
- Hematologic: Lymphocytes decreased
- Ocular: Irritation, redness, swelling
- Respiratory: Dry throat, dyspnea, throat tightness
- Miscellaneous: Hypersensitivity reactions including anaphylaxis
Notes:
- No known significant drug interactions
- Monitor: Blood pressure and heart rate during and after infusion, serum lactate levels, venous-arterial pO2, blood cyanide concentrations
- 5 g vial for IV use is not a Special Access Drug
- 1 mg/mL [30 mL vial] for IM use is a Special Access Drug