FAQ 2: What are the right antidotes and doses for Cyanide poisoning? How does it works (Mode of action)?

ANTIDOTE INDICATION MODE OF ACTION DOSAGE
Amyl Nitrite

 

Cyanide poisoning Facilitates conversion of hemoglobin to methemoglobin to inhibit cyanide’s affinity to cytochrome oxidase enzymes thereby inhibiting its toxic effects. Ampoule contents should be inhaled for 30 seconds every minute. Use new ampoule every three minutes.

 

Cyanokit (Hydroxo-cobalamin)

 

Cyanide poisoning Binds with cyanide ions to facilitate excretion into the urine. 5 grams through intravenous infusion for 15 minutes

 

Dicobalt edetate

 

Cyanide toxicity Forms stable ion-complexes with cyanide to facilitate its excretion in the urine. 300mg through intravenous push for 1 minute followed by 50mL of 50% dextrose. Initial dose may be repeated if inadequate and can be further followed by a 300mg dose.

 

Sodium nitrite

 

Cyanide/ acrylonitrite Nitrites facilitate conversion of hemoglobin to methemoglobin. Methemoglobin has higher binding affinity to cyanide which further facilitates its excretion 10mL of 3% sodium nitrite solution through IV for 5-20 minutes followed by sodium thiosulphate

 

Sodium thiosulphate

 

Cyanide/ acrylonitrite Acts as a precursor for the enzyme rhodanase which facilitates conversion of cyanide to non-toxic thiocyanate and thereby promoting its excretion. 50mL of 25% sodium thiosulphate through IV for ten minutes

 

Reference:

British National Formulary (BNF), 70th Edition.

 

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