Parenteral Manual


Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Antidote, Cyanide
Original Date: 
March 2011
Revised Date: 
March 2015
  • 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

- 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


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

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




(For neonatal dosages, refer to Neonatal IV Drug Manual.)


  • 70 mg/kg as a single infusion (maximum dose 5 g)
  • May repeat a second dose of 70 mg/kg (maximun dose 5 g)


  • 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
  • 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

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