Hydroxocobalamin also appears to have a better safety profile in the setting of cyanide poisoning in conjunction with smoke inhalation. Hydroxocobalamin offers an improved safety profile for children and pregnant women. In cases of cyanide ingestion, both the nitrite/thiosulfate combination and hydroxocobalamin are effective antidotes. Having an effective antidote readily available is essential for facilities that provide emergency care.

Randomized controlled trials of hydroxocobalamin and traditional cyanide antidotes (nitrites/thiosulfate) are lacking.Ĭyanide poisoning can rapidly cause death. Two studies examining hydroxocobalamin for smoke inhalation-associated cyanide poisoning indicated a possible benefit, but they are insufficient to establish definitive criteria for use in this setting. A retrospective study of 14 acute cyanide poisonings also demonstrated hydroxocobalamin's safety and efficacy. Hydroxocobalamin has been shown to reduce cyanide concentrations in controlled studies of nitroprusside therapy and in heavy smokers. A preclinical study demonstrated that intravenous doses of hydroxocobalamin 5 g are well tolerated by volunteer subjects. Studies of antidote efficacy in humans are ethically and logistically difficult. Four new studies were identified by the search and 3 studies were identified from the references. The literature search retrieved 7 studies on the safety and/or efficacy of hydroxocobalamin in humans. References from identified articles were reviewed for additional pertinent human studies. Systematic searches were conducted through January 2008. This search was then limited to human studies published since 2000. Relevant publications were identified through a systematic search of PubMed using the MeSH terms and key words hydroxocobalamin and cyanide. To review the recently approved cyanide antidote, hydroxocobalamin, and describe its role in therapy.

Hydroxocobalamin for cyanide poisoning