SODIUM THIOSULFATE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for SODIUM THIOSULFATE (SODIUM THIOSULFATE).
Sodium thiosulfate acts as a cyanide antidote by providing a sulfur donor for the enzyme rhodanese, which converts cyanide to the less toxic thiocyanate. It also acts as a reducing agent and chelator of calcium, forming soluble calcium thiosulfate complexes.
| Metabolism | Sodium thiosulfate is metabolized via the enzyme rhodanese (in liver and other tissues) to thiocyanate, which is then excreted renally. It also undergoes oxidation to sulfate. |
| Excretion | Renal: >90% unchanged; minor biliary/fecal. |
| Half-life | Terminal elimination half-life: 0.65 hours (IV in cyanide poisoning); context: rapid redistribution and excretion, requiring repeated doses. |
| Protein binding | <5%; primarily albumin. |
| Volume of Distribution | 0.2-0.3 L/kg; indicates primarily extracellular distribution. |
| Bioavailability | Oral: approximately 0% (poorly absorbed, degraded in stomach); IV: 100%. |
| Onset of Action | IV: 1-2 minutes; oral: onset unknown due to poor oral bioavailability. |
| Duration of Action | IV: 15-20 minutes (due to rapid redistribution and metabolism); clinical note: short duration necessitates repeated dosing for sustained thiocyanate generation. |
12.5 g (50 mL of 25% solution) intravenously over 10 minutes for cyanide poisoning; for cisplatin otoprotection: 9 g/m² intravenously over 15 minutes after cisplatin.
| Dosage form | SOLUTION |
| Renal impairment | No dose adjustment required for GFR >30 mL/min; for GFR ≤30 mL/min, consider reducing dose by 50% or extending interval to every 12 hours due to possible thiosulfate accumulation. |
| Liver impairment | No specific recommendations for Child-Pugh; use with caution in severe hepatic impairment due to potential metabolic and elimination effects. |
| Pediatric use | For cyanide poisoning: 412.5 mg/kg (1.65 mL/kg of 25% solution) intravenously over 10 minutes; for methemoglobinemia: 1 mg/kg intravenously over 10 minutes. |
| Geriatric use | No specific dose adjustments; monitor renal function and volume status due to sodium load and potential reduced clearance. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for SODIUM THIOSULFATE (SODIUM THIOSULFATE).
| Breastfeeding | Sodium thiosulfate is excreted into breast milk in small amounts; M/P ratio is not established. It is considered compatible with breastfeeding, but caution is advised due to limited data. |
| Teratogenic Risk | Sodium thiosulfate is not known to be teratogenic. No specific fetal risks have been identified; however, data in pregnant women are limited. It is used as an antidote for cyanide poisoning during pregnancy when benefit outweighs risk. |
| Fetal Monitoring |
■ FDA Black Box Warning
None.
| Serious Effects |
["Known hypersensitivity to sodium thiosulfate or any component","Relative: Severe renal impairment (risk of thiocyanate toxicity)"]
| Precautions | ["Hypotension and increased anion gap metabolic acidosis (especially with high doses or rapid infusion)","Hypocalcemia due to calcium chelation; monitor calcium levels","Thiocyanate accumulation, particularly in renal impairment; can lead to toxicity (e.g., nausea, disorientation, psychosis, muscle cramps)","Hydration status should be monitored to avoid volume overload","Hypersensitivity reactions may occur"] |
Loading safety data…
| Monitor for signs of cyanide toxicity (maternal and fetal) and adverse effects such as hypotension, headache, nausea, and metabolic acidosis. No specific fetal monitoring required beyond standard obstetric care. |
| Fertility Effects | No known adverse effects on fertility based on available animal and human data. |