cyanokit

Cyanokit is a brand-name antidote for cyanide poisoning that contains hydroxocobalamin, a form of vitamin B12, prepared for intravenous administration. It is used in emergencies to treat cyanide poisoning resulting from smoke inhalation, chemical exposure, or other sources of cyanide.

Mechanism of action: hydroxocobalamin binds cyanide ions to form cyanocobalamin, a non-toxic compound that is renally excreted. This binding rapidly reduces cytochrome c oxidase inhibition, restoring cellular respiration and oxygen utilization.

Administration and dosing: Cyanokit is given by intravenous infusion. The typical adult dose is 5 grams administered over about 15 minutes; a second 5-gram dose may be given if symptoms or signs of cyanide poisoning persist, for a total dose of up to 10 grams per episode. Pediatric dosing is weight-based but generally follows the same per-dose amount with a maximum of 5 g per dose; dosing may be repeated as clinically indicated.

Contraindications and cautions: contraindicated in patients with known hypersensitivity to hydroxocobalamin or cobalt. The solution can impart a red color to skin, mucous membranes, urine, and laboratory samples, potentially interfering with colorimetric assays and some point-of-care tests.

Adverse effects: flushing, hypertension or hypotension, tachycardia, nausea, vomiting, headache; transient chromaturia (reddish discoloration of urine) and skin discoloration are common but usually benign. Anaphylaxis is rare.

Regulatory status: Cyanokit has been approved for the treatment of cyanide poisoning in adults and children and is widely used in prehospital and hospital settings as part of emergency management.