FAQ / Fact Sheet
The following is a list of answers to the most commonly asked questions regarding CYANOKIT®.
- What is CYANOKIT®?
- CYANOKIT® is indicated for the treatment of known or suspected cyanide poisoning. Upon administration of CYANOKIT®, hydroxocobalamin directly binds cyanide, forming another form of vitamin B12, cyanocobalamin, which is excreted in the urine.29
- Is hydroxocobalamin injection approved in the United States to treat anemia? Can that product be used to treat cyanide poisoning?
- Hydroxocobalamin Acetate (1000-µg) is FDA-approved in the United States and is used to treat patients with severe vitamin B12 deficiency (most often caused by pernicious anemia).37 However, this product formulation is dosed as a 1,000 µg intramuscular (IM) injection—a fraction of the FDA-approved 5 g dosage for cyanide poisoning.29
- Is CYANOKIT® available anywhere else outside of the United States?
- The current answer to the question is:
CYANOKIT® has been approved for marketing in France since mid-1996 and in the EU since November 2007 to treat known or suspected cases of cyanide poisoning. CYANOKIT® is registered in Hong Kong.35 In other countries, CYANOKIT® is supplied on special request.
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- What is the dose and route of administration?
- The initial dose of CYANOKIT® for adults is 5 g, (two 2.5 g vials) administered by IV infusion over a total of 15 minutes. 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 the second 5 g dose ranges from 15 minutes (for patients in extremis) to 2 hours based on patient condition.29
- What is the mechanism of action of CYANOKIT®?
- CYANOKIT® contains the active ingredient hydroxocobalamin which forms a strong bond with cyanide forming nontoxic cyanocobalamin (another form of vitamin B12), which is then safely excreted from the body.29
- How is CYANOKIT® packaged?
- CYANOKIT® is packaged as two 2.5 g vials of lyophilized (freeze-dried) hydroxocobalamin along with two sterile transfer spikes, one IV administration set, user instructions and a Package Insert. After rapid reconstitution of each vial with 100 mL of 0.9% Sodium Chloride for Injection (not included in kit), each vial can be administered immediately.29
Note: Following the addition of diluent to the lyophilized powder, each vial should be repeatedly rotated or rocked, not shaken, for at least 29 seconds prior to infusion.
Discard reconstituted solution if it is not dark red or if particulate matter is seen after the solution has been appropriately mixed.
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- What are the most common adverse reactions with CYANOKIT®?
- The most common adverse reactions (>5%) are transient and include chromaturia (red-colored urine), erythema (skin redness), rash (acne-like), increased blood pressure, nausea, headache, decreased lymphocyte percent, and injection site reactions. Allergic reactions have been observed. Usage may interfere with some clinical laboratory evaluations.29
Please see full CYANOKIT® Prescribing Information for more detail.
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- When would a patient be administered CYANOKIT®?
- CYANOKIT® can be administered under the direction of a physician when clinical suspicion of cyanide poisoning is high. Intravenous administration can occur in the field or during in-hospital care.
Cyanide Risk
- What is the prevalence of cyanide poisoning in smoke inhalation victims in the United States?
- Smoke inhalation victims are not commonly tested for cyanide levels.3
However, as a result of fires in 2008, 16,705 civilians were injured and 3,320 civilians lost their
lives38 — and smoke inhalation is the primary cause of death in 60 to 80
percent of fire-related fatalities.8
- Of the overall population, who is at risk for cyanide poisoning?
- The risk of individuals being poisoned with cyanide is related to the extent to which they may come in contact with cyanide,
which can occur via inhalation, ingestion, dermal contact or parenteral administration.14,30 The risk may depend on the chance of becoming trapped in a closed-space fire,4 on length and degree of exposure in industrial or occupational settings,12 as well as on ingestion of cyanide-containing plants.12
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Cyanide and Cyanide Poisoning
- What is cyanide? Where can it be found?
- Cyanide is a chemical that can exist as a colorless gas or as white powder or crystals. Both the gas, called hydrogen cyanide, and the crystals, called sodium cyanide or potassium cyanide, have a faint, bitter, almond-like odor.16
Cyanide exposure can potentially occur through the following sources:
- Cyanide Poisoning in Smoke Inhalation - Cyanide in a gaseous form may be produced during structure fires, when products containing carbon and nitrogen, such as wool, paper, cotton, silk and plastics, burn. Inhaling smoke from one of these common building fires is the most common source of cyanide poisoning3,4,11,13,18
- Industry-Related Cyanide Poisoning - Cyanide is widely used in many United States industries, primarily as an intermediary in industrial processes that result in products used in building construction, transportation vehicle interiors, and in residential or commercial building interiors and furnishings. It is also used in mining to remove gold from its ore14,17
- Cyanide Poisoning in a Terrorist Attack - Because cyanide is widely used in industry and sometimes easily attainable, cyanide can potentially be accessed or made and used to cause poisoning, generally through inhalation, ingestion, or skin exposure. Since fires may be a result of other types of terrorist activities, smoke inhalation could also be a source of cyanide poisoning during a terrorist incident15
- What happens when someone has been poisoned with cyanide?
- Cyanide poisoning may occur through inhalation, ingestion, dermal exposure or parenteral administration.30 The inhalation route results in the most rapid effect in the body. When hydrogen cyanide is inhaled, it quickly enters the bloodstream through the lungs and rapidly enters cells where it deactivates cytochrome oxidase, an enzyme found in cells and important in cell respiration, and prevents the cells from using oxygen. The brain and the heart are most vulnerable to the effects of cyanide poisoning because they are most dependent on oxygen to function properly.29,30 Therefore, the first symptoms of cyanide poisoning appear at the neurological and cardiovascular levels.30,39
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- How quickly does a cyanide-poisoning victim need to be treated?
- This depends upon the route of exposure and severity of the poisoning.39 For inhalation or ingestion of large doses, treatment must be instituted as quickly as possible, preferably within up to one hour from exposure. For certain cases of ingested or dermal cyanide exposure, the treatment window may be up to several hours.39 Delays in treatment should be avoided. Since smoke inhalation is the most common source of exposure, having an antidote available for the rapid, pre-hospital treatment may help save lives.29,31
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