Parenteral Manual

Sodium thiosulfate

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Alternate Name(s): 
Original Date: 
August 2005
Revised Date: 
April 2020
  • Cyanide or arsenic poisoning (alone or with sodium nitrite or amyl nitrite)
  • Reduce the risk of ototoxicity associated with cisplatin therapy
  • Local infiltration (in diluted form) of selected chemotherapy extravasation (off-label use)
Reconstitution and Stability: 
  • Available as a 25% (250mg/mL)  preservative free injectable solution  
  • Store at room temperature. Protect from light
  • For cyanide or arsenic poisoning (alone or with sodium nitrite or amyl nitrite)
    • Stable diluted in NS or D5W at concentrations of 1.5% and 9.76% for 24 hours
  • For prevention of cisplatin induced ototoxity
    • Dilute each mL of the 25% Sodium Thiosulfate with 1 mL of sterile water for injection (1:1 dilution) for a 12.5% (125 mg/mL) solution for administration.  (This has an approximately equivalent isotonicity to a 2.3% sodium chloride solution).  MUST be administered within 4 hours of reconstitution.



- Solutions Compatible: D5W, NS, Sterile Water for Injection



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

IV Direct


IV Intermittent Infusion YES  - Central line preferred
Usual dilution: undiluted (or as per protocol)
Infusion time: slowly over at least 15 minutes (or as per protocol)
Infusion rate: 0.625-1.25 g/min (2.5-5 mL/min) (or as per protocol)
IV Continuous Infusion NO




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

Cyanide and nitroprusside antidote:

  • Children <25 kg: 412.5 mg/kg (1.65 mL/kg of 25% solution) or 7g/ /m2   (max 12.5 g) 
  • Children >25 kg and adults: 12.5 g IV (50 mL of 25% solution) after 300 mg sodium nitrite;  one half the dose of each may be repeated if necessary

Cisplatin toxicity:


  • 12 g IV over 6 hours in association with cisplatin or
  • 9 g/m2 IV bolus then 1.2 g/m2/hour IV for 6 hours; should be given before or during cisplatin administration

Prevention of Cisplatin-induced ototoxicity:

  • Weight > 10 kg: 20 g/m2/dose
  • Weight 5 - 10 kg: 15 g/m2/dose
  • Weight < 5 kg: 10 g/m2/dose
  • Given over 15 minutes beginning 6 hours after completion of each Cisplatin infusion.

Chemotherapy infiltration: (add 1.6 mL of 25% sodium thiosulfate to 8.4 mL of Sterile Water for Injection  to get total volume of 10 mL)

  • Mechlorethamine: use 2 mL for each mg infiltrated
  • Cisplatin: 2 mL for each 100 mg infiltrated; use only for large infiltrates (>20 mL) and concentrations >0.5 mg/mL of cisplatin
Potential hazards of parenteral administration: 
  • Hypotension (increased incidence with rapid IV injection) or transient hypertension
  • Transient hypernatremia
  • Nausea, vomiting  (occasional 5 - 20%)
  • Headache, disorientation, agitation, delusions, hallucinations
  • Local irritation:  contact dermatitis if extravasation
  • Hypersensitivity reactions
  • For prevention of cisplatin induced ototoxicity
    • Monitor blood pressure:  Prior to each dose, immediately after infusion completion and every 15 minutes until 2 consecutive stable blood pressures obtained. 
    • Premedicate with antiemetics.  Coordinate timing with antiemetics administered for the chemotherapy protocol.
                         - Corticosteroid use is accepted if permitted by the chemotherapy protocol.
  • Renal impairment:  Use with caution in patients with renal impairment;  thiocyanate (produced when sodium thiosulfate combines with cyanide) is eliminated by the kidneys.  Avoid concurrent administration of nephrotoxic drugs when possible. 

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