However, it can be very toxic and cause seizures, upper airway oedema, chest pain, hypotension, vomiting, rashes and dyspnoea especially in those who have not be exposed to cyanide. Other antidotes such as hydroxocobalamin or sodium thiosulphate are preferred. Never give to a patient without definite severe cyanide toxicity.
- To be administered in an area with full resuscitative care. Cardiac monitoring is mandatory.
- 300mg (1 ampoule) IV over 1 minute, followed with 50ml of 50% dextrose IV to protect against toxicity.
- 2nd or 3rd doses are given if an immediate clinical response is not seen (improved GCS, haemodynamic stability, improvement in metabolic acidosis).
- Paediatric Dose = 7.5mg/kg (maximum 300mg)
- Hall A, Saiers J, Baud F. Which cyanide antidote? Critical Reviews in Toxicology 2009; 39(7):541-552.
- IPCS/CEC evaluation of antidotes series. Volume 2. Antidotes for poisoning by cyanide. Meredith TJ, Jacobsen D, Haines JA and Berger J-C. Cambridge University Press 1993.