Pharmacology. Sodium thiosulfate is a sulfur donor that promotes the conversion of cyanide to the less toxic thiocyanate by the sulfur transferase enzyme rhodanese. Unlike nitrites, thiosulfate is essentially nontoxic and may be given empirically in suspected cyanide poisoning. Animal studies suggest enhanced antidotal efficacy when hydroxocobalamin is used with thiosulfate. Sodium thiosulfate has poor oral bioavailability. Following IV injection, sodium thiosulfate is extensively distributed into the extracellular fluids and excreted unchanged in the urine, with a reported half-life of 0.65 hour.

Indications

1. 
   

   May be given alone or in combination with nitrites (See Nitrite, Sodium and Amyl) or hydroxocobalamin (See Hydroxocobalamin) to patients with acute cyanide poisoning; may also be used as empiric treatment of possible cyanide poisoning associated with smoke inhalation.

   
   
2. 
   

   Prophylaxis during nitroprusside infusions (See Nitroprusside).

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