Sodium thiosulfate (medical use)

Sodium thiosulfate
Sodium thiosulfate, structural formula
Clinical data
Trade names Versiclear, others
AHFS/Drugs.com Micromedex Detailed Consumer Information
Pregnancy
category
  • US: C (Risk not ruled out)
    ATC code
    Identifiers
    CAS Number
    PubChem CID
    ChemSpider
    UNII
    ChEBI
    Chemical and physical data
    Formula Na2S2O3
    Molar mass 158.108
    3D model (JSmol)

    Sodium thiosulfate, also spelled sodium thiosulphate, is used as a medication to treat cyanide poisoning, pityriasis versicolor, and to decrease side effects from cisplatin.[1][2] For cyanide poisoning it is often used after the medication sodium nitrite and typically only recommended for severe cases.[1][3] It is either given by injection into a vein or applied to the skin.[1]

    Side effects may include vomiting, joint pain, mood changes, psychosis, and ringing in the ears.[2] Safety; however, has not been well studied.[4] It is unclear if use in pregnancy is safe for the baby.[2] Use at the same time in the same intravensous line as hydroxocobalamin is not recommended.[3] In cyanide poisoning sodium nitrite creates methemoglobinemia which removes cyanide from mitochondria.[3] Sodium thiosulfate then binds with cyanide creating the nontoxic thiocyanate.[3]

    Sodium thiosulfate came into medical use for cyanide poisoning in the 1930s.[5] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[6] The cost in the United States per dose as of 2013 is about 20 USD while together with sodium nitrite it costs 110 USD.[7]

    Medical uses

    The main use of sodium thiosulfate is in cyanide poisoning and pityriasis versicolor.[1]

    Cyanide poisoning

    In cyanide poisoning there are concerns that sodium thiosulfate may not have a fast enough onset of action to be very useful without the additional use of other agents.[8]

    In those who have both cyanide poisoning and carbon monoxide poisoning sodium thiosulfate by itself is recommended.[9]

    Other

    There is also a small amount of evidence supporting its use in calciphylaxis, where blood vessels calcify.[10]

    References

    1. 1 2 3 4 WHO Model Formulary 2008 (PDF). World Health Organization. 2009. pp. 66, 298. ISBN 9789241547659. Archived (PDF) from the original on 13 December 2016. Retrieved 8 January 2017.
    2. 1 2 3 "Sodium thiosulfate Intravenous Advanced Patient Information - Drugs.com". www.drugs.com. Archived from the original on 18 January 2017. Retrieved 15 January 2017.
    3. 1 2 3 4 "Sodium Thiosulfate Solution for Injection - Summary of Product Characteristics (SPC) - (eMC)". www.medicines.org.uk. Archived from the original on 16 January 2017. Retrieved 15 January 2017.
    4. ↑ "Sodium Thiosulfate Injection - FDA prescribing information, side effects and uses". www.drugs.com. Archived from the original on 18 January 2017. Retrieved 15 January 2017.
    5. ↑ Dart, Richard C. (2004). Medical Toxicology. Lippincott Williams & Wilkins. p. 172. ISBN 9780781728454. Archived from the original on 2017-01-16.
    6. ↑ "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016.
    7. ↑ Gasco, L; Rosbolt, MB; Bebarta, VS (April 2013). "Insufficient stocking of cyanide antidotes in US hospitals that provide emergency care". Journal of Pharmacology & Pharmacotherapeutics. 4 (2): 95–102. PMID 23761707.
    8. ↑ Hall, AH; Dart, R; Bogdan, G (June 2007). "Sodium thiosulfate or hydroxocobalamin for the empiric treatment of cyanide poisoning?". Annals of Emergency Medicine. 49 (6): 806–13. PMID 17098327.
    9. ↑ Baren, Jill M. (2008). Pediatric Emergency Medicine. Elsevier Health Sciences. p. 1018. ISBN 978-1416000877. Archived from the original on 2017-01-16.
    10. ↑ Auriemma, M; Carbone, A; Di Liberato, L; Cupaiolo, A; Caponio, C; De Simone, C; Tulli, A; Bonomini, M; Amerio, P (1 October 2011). "Treatment of cutaneous calciphylaxis with sodium thiosulfate: two case reports and a review of the literature". American Journal of Clinical Dermatology. 12 (5): 339–46. PMID 21834598.
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