Alternate Name(s):
DISODIUM THIOSULFATE PENTAHYDRATE, SODIUM HYPOSULFATE
Classification:
Antidote
Original Date:
August 2005
Revised Date:
April 2020
Indications:
- 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.
Compatibility:
- Solutions Compatible: D5W, NS, Sterile Water for Injection
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 - 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 |
Dosage:
(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:
Adults:
- 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
Notes:
- 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.