Easy to Prepare and Administer in 4 Simple Steps


Recommended Dosing1

  • The starting dose of CYANOKIT® for adults is 5 g (contained in a single vial), administered by IV infusion over 15 minutes (approximately 15 mL/min)
  • Depending upon the severity of the poisoning and the clinical response, a second dose of 5 g may be administered by IV infusion up to a total dose of 10 g
  • The rate of infusion for a potential second dose may range from 15 minutes (for patients in extremis) to 2 hours, as clinically indicated

Preparation and Administration1

Complete Starting Dose: 5 g
  1. Reconstitute: Place the vial in an upright position.
    Add 200 mL of 0.9% Sodium Chloride Injection* to the vial using the transfer spike. Fill to the line.

    *0.9% Sodium Chloride Injection is the recommended diluent (diluent not included in the kit). Lactated Ringer's Solution and 5% Dextrose Injection have also been found to be compatible with hydroxocobalamin.

  2. Mix: The vial should be repeatedly inverted or rocked, not shaken, for at least 60 seconds prior to infusion.
  3. Infuse Vial: Use vented intravenous tubing, hang and infuse over 15 minutes.

One 5-g vial is a complete starting dose.

  • CYANOKIT® solutions should be visually inspected for particulate matter and color prior to administration
    • Discard solution if particulate matter is present or solution is not dark red
  • Caution should be exercised when administering other cyanide antidotes simultaneously with CYANOKIT®, as safety 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
 Preparation and Administration of Cyanokit

CYANOKIT® Incompatibility Information1

  • Physical incompatibility (particle formation) and chemical incompatibility were observed with the mixture of CYANOKIT® in solution with select drugs that are frequently used in resuscitation efforts
  • Chemically incompatible with sodium thiosulfate and sodium nitrite
  • Reported to be incompatible with ascorbic acid
  • Simultaneous administration of CYANOKIT® and blood products (whole blood, packed red cells, platelet concentrate and/or fresh frozen plasma) through the same line is not recommended (may be administered simultaneously through separate IV lines)

NOTE: Do not administer the aforementioned agents simultaneously in the same IV line.

Storage Information1

Lyophilized form: Store at 25°C (77°F); excursions permitted to 15° to 30°C (59° to 86°F). CYANOKIT® may be exposed, during short periods, to temperature variations of usual transport, transport in the desert, and freezing/defrosting cycles.
  • Usual transport defined as 15 days subjected to temperatures ranging from 5° to 40°C (41° to 104°F)
  • Transport in the desert defined as 4 days subjected to temperatures ranging from 5° to 60°C (41° to 140°F)
  • Freezing/defrosting cycles defined as 15 days subjected to temperatures ranging from -20° to 40°C (-4° to 104°F)

Storage of Reconstituted Drug Product: Once reconstituted, hydroxocobalamin is stable for up to 6 hours at temperatures not exceeding 40°C (104°F).
Do not freeze. Any reconstituted product not used by 6 hours should be discarded.

Please see single 5-g vial full Prescribing Information for complete instructions regarding dosing, preparation, administration, incompatibility, and storage information.

Recommended Dosing15

  • The starting dose of CYANOKIT® for adults is 5 g (ie, both 2.5-g vials), administered by IV infusion over a total of 15 minutes (approximately 15 mL/min), 7.5 minutes per vial
  • Depending upon the severity of the poisoning and the clinical response, a second dose of 5 g may be administered by IV infusion up to a total dose of 10 g
  • The rate of infusion for a potential second dose may range from 15 minutes (for patients in extremis) to 2 hours, as clinically indicated

Preparation and Administration4

Starting Dose: 5 g (two 2.5-g vials)
  1. Reconstitute: Add 100 mL of 0.9% Sodium Chloride Injection* to vial using sterile transfer spike. Fill to line. Vial in upright position.

    *0.9% Sodium Chloride Injection is the recommended diluent (diluent not included in the kit). Lactated Ringer's Solution and 5% Dextrose Injection have also been found to be compatible with hydroxocobalamin.

  2. Mix: Rock or rotate vial for 30 seconds to mix solution. Do not shake.
  3. Infuse First Vial: Use vented IV tubing to hang and infuse over 7.5 minutes.
  4. Infuse Second Vial (repeat steps 1 and 2 before second infusion): Use vented IV tubing to hang and infuse over
    7.5 minutes.
  • CYANOKIT® solutions should be visually inspected for particulate matter and color prior to administration
    • Discard solution if particulate matter is present or solution is not dark red
  • Caution should be exercised when administering other cyanide antidotes simultaneously with CYANOKIT®, as safety 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
 Preparation and Administration of Cyanokit

CYANOKIT® Incompatibility Information4

  • Physical incompatibility (particle formation) and chemical incompatibility were observed with the mixture of CYANOKIT® in solution with select drugs that are frequently used in resuscitation efforts
  • Chemically incompatible with sodium thiosulfate and sodium nitrite
  • Reported to be incompatible with ascorbic acid
  • Simultaneous administration of CYANOKIT® and blood products (whole blood, packed red cells, platelet concentrate and/or fresh frozen plasma) through the same line is not recommended (may be administered simultaneously through separate IV lines)

NOTE: Do not administer the aforementioned agents simultaneously in the same IV line.

Storage Information4

Lyophilized form: Store at 25°C (77°F); excursions permitted to 15° to 30°C (59° to 86°F). CYANOKIT® may be exposed, during short periods, to temperature variations of usual transport, transport in the desert, and freezing/defrosting cycles.
  • Usual transport defined as 15 days subjected to temperatures ranging from 5° to 40°C (41° to 104°F)
  • Transport in the desert defined as 4 days subjected to temperatures ranging from 5° to 60°C (41° to 140°F)
  • Freezing/defrosting cycles defined as 15 days subjected to temperatures ranging from -20° to 40°C (-4° to 104°F)

Storage of Reconstituted Drug Product: Once reconstituted, hydroxocobalamin is stable for up to 6 hours at temperatures not exceeding 40°C (104°F).
Do not freeze. Any reconstituted product not used by 6 hours should be discarded.

Please see two 2.5-g vial full Prescribing Information for complete instructions regarding dosing, preparation, administration, incompatibility, and storage information.

Indication
CYANOKIT® (hydroxocobalamin for injection) 5 g for intravenous infusion is indicated for the treatment of known or suspected cyanide poisoning. If clinical suspicion of cyanide poisoning is high, CYANOKIT® should be administered without delay.

Important Safety Information
Cyanide poisoning may result from inhalation, ingestion, or dermal exposure. Prior to administration of CYANOKIT®, smoke-inhalation victims should be assessed for: exposure to fire or smoke in an enclosed area; presence of soot around the mouth, nose, or oropharynx, and altered mental status. In addition to CYANOKIT®, treatment of cyanide poisoning must include immediate attention to airway patency, adequacy of oxygenation and hydration, cardiovascular support, and management of any seizure activity.

Use caution in the management of patients with known anaphylactic reactions to hydroxocobalamin or cyanocobalamin. Allergic reactions may include: anaphylaxis, chest tightness, edema, urticaria, pruritus, dyspnea, rash, and angioneurotic edema. Substantial increases in blood pressure may occur following CYANOKIT® therapy. Usage may interfere with some clinical laboratory evaluations. Also, because of its deep red color, hydroxocobalamin may cause hemodialysis machines to shut down due to an erroneous detection of a "blood leak." This should be considered before hemodialysis is initiated in patients treated with hydroxocobalamin. Due to potential photosensitivity, patients should avoid direct sun until erythema resolves.

CYANOKIT® is Pregnancy Category C and should be used during pregnancy only if the potential benefit justifies the potential risk. Safety and effectiveness of CYANOKIT® have not been established in pediatric patients. The most common adverse reactions (>5%) are transient and include chromaturia, erythema, rash (predominantly acneiform), increased blood pressure, nausea, headache, decreased lymphocyte percentage, and injection site reactions.

Please see single 5-g vial full Prescribing Information. Please see two 2.5-g vial full Prescribing Information.

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