Thiosulfate
Thiosulfate is an antidote medication used to treat cyanide poisoning, a life-threatening emergency where cyanide blocks cellular respiration by inhibiting cytochrome oxidase. It works by converting toxic cyanide into thiocyanate, a compound that can be safely eliminated from the body through the kidneys.
Thiosulfate is an emergency antidote for cyanide poisoning that converts cyanide into a harmless compound for excretion.
Key facts at a glance
- ATC
- V03AB06
- RxNorm
- 1546411
- Generic
- Thiosulfate
- Class
- atc-v03
- Brands
- Pedmark, Exoderm, Versiclear
- Availability
- rx
- Lactation
- unknown
- Routes
- topical
- Forms
- injection
- Regions
- US, EU, CN, JP
- Monitoring
- —
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Dosage and administration
- Usual dose
- 12.5g IV
- Maximum
- consult physician
- Frequency
- as single dose or repeat
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 600mg/m² twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 12.5g IV
- Maximum
- consult physician
- Frequency
- as single dose or repeat
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
Overdose information
Special Populations
8 groupspregnancy
first trimesteravoid if possible
avoid use during pregnancy unless benefits outweigh risks - limited human data available
regular fetal monitoring and ultrasound assessments
Use of this medication in this population requires careful consideration of risks and benefits.
pregnancy
second trimesteruse lowest effective dose
use only when clearly indicated, weigh risks vs benefits carefully
fetal monitoring recommended
Use with caution and monitor for adverse effects.
pregnancy
third trimesteruse lowest effective dose
use only when benefits outweigh risks - close obstetric monitoring required
continuous fetal monitoring and uterine activity assessment
Use with caution and monitor for adverse effects.
lactation
breastfeedingcaution advised
discontinue breastfeeding or avoid thiosulfate - excretion in breast milk unknown
monitor infant for adverse effects
geriatric
elderlystart with lower dose and adjust based on renal function
use with caution due to age-related decline in renal function
monitor renal function and electrolytes regularly
Use with caution and monitor for adverse effects.
pediatric_age
childrenweight-based dosing required
approved for prevention of cisplatin-induced ototoxicity in pediatric patients 1 month and older
monitor hearing function, renal function, and electrolytes
renal_impairment
moderate to severesignificant dose reduction required - monitor serum levels
reduce dose in patients with CrCl less than 30 mL/min - used therapeutically for calciphylaxis in renal failure patients
frequent monitoring of renal function, electrolytes, and thiosulfate levels
Use with caution and monitor for adverse effects.
hepatic_impairment
moderateuse with caution
limited data available - use with caution in hepatic impairment
monitor liver function tests
Statistics and clinical data
FDA approved indications
Primary FDA-approved therapeutic indications for sodium thiosulfate
Drug class
Pharmacological classification of thiosulfate
Brand names
Commercial brand names for sodium thiosulfate products
Mechanism of action
Pharmacodynamic mechanism for otoprotection
Treatment of acute cyanide poisoning from sources such as industrial chemical exposure, smoke inhalation (especially from synthetic materials), certain medications like sodium nitroprusside, or intentional/accidental ingestion. Used in both emergency department and pre-hospital settings when cyanide toxicity is suspected.
Thiosulfate provides sulfur donor molecules that are utilized by the enzyme rhodanese to convert cyanide into thiocyanate through a sulfur transfer reaction. Thiocyanate is approximately 200 times less toxic than cyanide and is readily excreted by the kidneys, thereby reversing the inhibition of cytochrome oxidase and restoring normal cellular respiration.
Administered intravenously, often concurrently with 100% oxygen and supportive care. May be used alongside other cyanide antidotes like hydroxocobalamin. Renal function should be assessed as thiocyanate accumulation can occur in patients with kidney impairment. Common side effects include hypotension and metabolic changes; high doses may cause GI disturbances.
Contraindications
Conditions and patient states where this medication should be avoided or used with caution.
Do not use (1)
Known allergy to this medication or its components
Use caution (1)
Consult healthcare provider for benefits vs risks assessment
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed July 26, 2026. · Read our editorial policy