RT Book, Section A1 Howland, Mary Ann A2 Hoffman, Robert S. A2 Howland, Mary Ann A2 Lewin, Neal A. A2 Nelson, Lewis S. A2 Goldfrank, Lewis R. SR Print(0) ID 1108423289 T1 Antidotes in Depth T2 Goldfrank's Toxicologic Emergencies, 10e YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 9780071801843 LK accesspharmacy.mhmedical.com/content.aspx?aid=1108423289 RD 2024/03/29 AB Sodium thiosulfate is a safe and effective antidote that detoxifies cyanide by donating a sulfur moiety to form thiocyanate. Thiocyanate is much less toxic than cyanide and is renally eliminated. Sodium thiosulfate works synergistically with nitrites and is probably at least additive to hydroxocobalamin in the detoxification of cyanide. Because sodium thiosulfate does not compromise hemoglobin oxygen saturation, it can be used without nitrites in circumstances where the formation of methemoglobin would be detrimental, as in patients who have elevated levels of carboxyhemoglobin or preexistent methemoglobinemia from smoke inhalation, drug exposure, or congenital dyshemoglobinemias when hydroxocobalamin is unavailable. Based on the mechanism of action of sodium thiosulfate, particularly when used alone, it is unlikely to be as effective as hydroxocobalamin, or work as quickly. A recent study in a swine cyanide model could not show a benefit of sodium thiosulfate as sole therapy or show an added benefit to that offered by hydroxocobalamin.3 Sodium thiosulfate is used prophylactically with nitroprusside to prevent cyanide toxicity. Sodium thiosulfate is also used to treat calcific uremic arteriolopathy (calciphylaxis) theoretically by increasing the solubility of calcium deposits, inducing vasodilation, and acting as a free radical scavenger.6,24,28,32