cyanokit.txt

• Cyanokit®
• (Hydroxocobalamin)

Cyanide Antidote

The active ingredient in Cyanokit, hydroxocobalamin, is a precursor of vitamin B12. Hydroxocobalamin works by binding directly to the cyanide ions, creating cyanocobalamin, a natural form of vitamin B12, which is excreted in the urine. Advantages of this approach are that methemoglobin is not produced and the oxygen-carrying capacity of the victim's blood is not lowered.

Cyanokit® is indicated for the treatment of known or suspected cyanide poisoning

There are no known contraindications to the use of the Cyanokit®

• Injection site redness
• Temporary discoloration of the skin, urine and mucous membranes
• Transient elevations in blood pressure

• Blood/Blood Products
• Diazepam
• Dobutamine
• Dopamine
• Fentanyl
• Nitroglycerin
• Pentobarbital
• Propofol

• Each Cyanokit® carton (NDC 49502-550-2) consists of the following:
• Two 250 mL glass vials, each containing lyophilized hydroxocobalamin for injection, 2.5 g
• Two sterile transfer spikes
• One sterile IV infusion set
• One quick use reference guide
• One package insert
• Note: Diluent not provided in carton. Each 2.5 g vial is to be reconstituted with 100 mL of 0.9% NaCl, Lactated Ringers injection, or 5% Dextrose injection (D5W) using the transfer spike packaged with the medication

• The starting dose of hydroxocobalamin for adults is 5 g (i.e., both 2.5g vials) administered as an intravenous (IV) infusion over 15 minutes (approximately 15 mL/min), i.e., 7.5 minutes/vial.
• Depending upon the severity of the poisoning and the clinical response, a second dose of 5 g may be administered by IV infusion for a total dose of 10 g. The rate of infusion for the second dose may range from 15 minutes (for patients in extremis) to two hours, as clinically indicated.

Safety and effectiveness of Cyanokit® have not been established in this population. In non-US marketing experience, a dose of 70 mg/kg has been used to treat pediatric patients.

24 hours to 35 days

• Pregnancy safety: Category C
• Caution should be exercised when administering other cyanide antidotes simultaneously with Cyanokit, as the safety of co-administration has not been established. If a decision is made to administer another cyanide antidote with Cyanokit, these drugs should not be administered concurrently in the same IV line.