Hydroxocobalamin and sodium thiosulfate can be combined safely. Therefore, theoretically, there is a synergistic action of sodium thiosulfate and hydroxocobalamin 1,2 1,2. Sodium thiosulfate acts as a sulfur donor to detoxify cyanide to thiocyanate by the enzyme rhodanese, whereas hydroxocobalamin binds cyanide and forms the nontoxic cyanocobalamin, which is renally excreted. Its use as a single antidote for acute cyanide toxicity is no longer supported or indicated 1,2 1,2.īecause of its immediate diffusion into the different tissue compartments, intravenously administered hydroxocobalamin has a rapid onset of action. We wish to thank Bebarta for drawing our attention to the position of sodium thiosulfate in the treatment of cyanide toxicity and giving us the opportunity to clarify our statements.Īlthough sodium thiosulfate is considered an ineffective antidote for acute cyanide toxicity because of poor intracellular penetration, slow onset of effect, a short half-life, and limited distribution volume, it is often used in conjunction with other rapid-acting antidotes.

Cyanide poisoning antidote mechanism