2 In light of the experts’ recommendation to use hydroxocobalamin, and the absence of amyl nitrite on the FDA list of approved cyanide antidotes, 3 amyl nitrite is no longer an acceptable antidote option.Įmployers that offer antidote therapy for cyanide poisoning should provide one of the FDA-approved products. 3 In 2018, an expert consensus panel determined that hydroxocobalamin is the preferred antidote, but sodium nitrite and sodium thiosulfate are also acceptable. Food and Drug Administration (FDA) stated, as of September 2018, that the only products approved for cyanide poisoning are the following: Cyanokit (hydroxocobalamin injection), Nithiodote (sodium nitrite and sodium thiosulfate for intravenous infusion), sodium nitrite injection, and sodium thiosulfate injection.
The three available antidotes are given via intravenous (IV) infusion and, therefore, can only be administered by qualified healthcare professionals.Īntidote kits containing inhaled amyl nitrite are no longer commercially available. Currently, the available cyanide antidotes are hydroxocobalamin, sodium nitrite, and sodium thiosulfate. Amyl nitrite (which was given via inhalation) is no longer available in cyanide antidote kits in the U.S., and is no longer an acceptable initial therapeutic response. This memo provides the following updated information regarding cyanide antidotes: According to current literature, hydroxy cobalamine has had limited use as an alternative intravenous medication to the widely accepted sodium nitrite protocol.” 1 This memorandum serves as new guidance to address outdated information provided in OSHA’s archived memo dated May 17, 1988, from the Office of Occupational Medicine, and entitled “Cyanide Antidote Kits.” The prior memo stated in part, “ Amyl Nitrite continues to require a physician’s prescription and the administration of this drug in an emergency situation by the designated first aide responder is the medically accepted initial response. 
KAPUST, Acting Directorĭirectorate of Enforcement Programs SUBJECT: Cyanide Antidotes Principal Deputy Assistant Secretary FROM: LEE ANNE JILLINGS, Acting Directorĭirectorate of Technical Support and Emergency Management PATRICK J. STATE PLAN DESIGNEES THROUGH: LOREN SWEATT
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