Rapid Recognition and Prompt Response Can Save Lives


  • Currently, there is no diagnostic test to confirm cyanide (CN) poisoning within the limited window for initiating potentially lifesaving intervention21
    • Even at most hospitals, rapid measurements of CN are not available21
    • Lactate levels may be tested as levels increase proportionally with the amount of CN poisoning because of the metabolic acidosis6,7
  • By contrast, carbon monoxide (CO) poisoning can be readily assessed with a transcutaneous CO-oximeter21
  • Further, CN and CO poisoning can be difficult to differentiate due to common signs and symptoms21
  • Signs and symptoms of acute CN toxicity also mimic those of O2 deprivation21
    • These include headache, dizziness, stupor, anxiety, rapid breathing, and increased heart rate

Moderate to Severe Poisoning Signs/Symptoms6,21

Shared signs/symptoms
  • Cyanide (CN) is a fast-acting poison—rapid recognition and prompt response can help save lives22
  • In moderate to severe poisoning, death can occur within minutes without treatment2

In addition to antidotal therapy, treatment of cyanide poisoning must include immediate attention to airway patency, adequacy of oxygenation and hydration, cardiovascular support, and management of any seizure activity.

Smoke Inhalation

Not all smoke-inhalation victims will have CN poisoning and may present with burns, trauma, and exposure.1 CN poisoning should be suspected if the following manifestations are present*1,2:
  • Exposure to fire or smoke in an enclosed area
  • Soot around mouth, nose, or back of mouth
  • Altered mental status (eg, confusion, disorientation)
*List may not be comprehensive.

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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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