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RX ITEM-Sodium Thiosulfate 12.5G/50Ml Vial 50Ml By Hope Pharma

NDC 60267-0705-50 UPC/GTIN No.3-60267-70550-7 Mfg.Part No.70550BRAND: SODIUM THIOSULFATE NDC: 60267-0705-50,60267070550 UPC: 3-60267-70550-7,360267705507 Hope PharmaceuticalsOnly Lic.-Physician,Pharmacy,Dentist,Drug Mfg,Dist.,Gov,Hospital,Lic.Lab,Naturalist,Naturopath,NP,Optometrist,Pharmacist,PA,Physical Therapist,Podiatrist,Research Co.,Uni.,VA,Vet & Wholesalers in scopWant to do Research on this Med or need a large quantity? Email Details with quantity required to:sales@AmericanPharmaWholesale.comVisit AmericanPharmaWholesale.com for over 100,000 items of Health & Beauty at Retail@Wholesale prices.Sodium Thiosulfate 12.5G/50ml Vial 50ml by Hope Pharma

RX ITEM-Sodium Thiosulfate 12.5G/50Ml Vial 50Ml By Hope Pharma

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item No.:RX217323 NDC No.60267070550 UPC No.:360267705507 NDC No.60267-0705-50 60267-705-50 UPC/GTIN No.3-60267-70550-7 MPN 70550 Only Lic.-Physician,Pharmacy,Dentist,Drug Mfg,Dist.,Gov,Hospital,Lic.Lab,Naturalist,Naturopath,NP,Optometrist,Pharmacist,PA,Physical Therapist,Podiatrist,ResearchCo.,Uni.,VA,Vet & Wholesalers in scope of practice can order this RX item. Rx Item No.Rx217323 Sodium Thiosulfate 12.5G/50ml Vial 50ml by Hope Pharma Item No.3217323 NDC No.60267070550 6026770550 UPC No.36026

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SODIUM THIOSULFATE- sodium thiosulfate injection, solution
Hope Pharmaceuticals
1 INDICATIONS AND USAGE
1.1 Indication

Sodium Thiosulfate Injection is indicated for sequential use with sodium nitrite for the treatment of acute cyanide poisoning that is judged to be life-threatening. When the diagnosis of cyanide poisoning is uncertain, the potential risks associated with Sodium Thiosulfate Injection should be carefully weighed against the potential benefits, especially if the patient is not in extremis.
1.2 Identifying Patients with Cyanide Poisoning

Cyanide poisoning may result from inhalation, ingestion, or dermal exposure to various cyanide-containing compounds, including smoke from closed-space fires. Sources of cyanide poisoning include hydrogen cyanide and its salts, cyanogenic plants, aliphatic nitriles, and prolonged exposure to sodium nitroprusside.

The presence and extent of cyanide poisoning are often initially unknown. There is no widely available, rapid, confirmatory cyanide blood test. Treatment decisions must be made on the basis of clinical history and signs and symptoms of cyanide intoxication. If clinical suspicion of cyanide poisoning is high, Sodium Thiosulfate Injection and Sodium Nitrite Injection should be administered without delay.
Table 1. Common Signs and Symptoms of Cyanide Poisoning Symptoms Signs

Headache
Confusion
Dyspnea
Chest Tightness
Nausea



Altered Mental Status
(e.g., confusion, disorientation)
Seizures or Coma
Mydriasis
Tachypnea/Hyperpnea (early)
Bradypnea/Apnea (late)
Hypertension (early)/ Hypotension (late)
Cardiovascular Collapse
Vomiting
Plasma Lactate Concentration ≥ 8 mmol/L

In some settings, panic symptoms including tachypnea and vomiting may mimic early cyanide poisoning signs. The presence of altered mental status (e.g., confusion and disorientation) and/or mydriasis is suggestive of true cyanide poisoning although these signs can occur with other toxic exposures as well.

The expert advice of a regional poison control center may be obtained by calling 1-800-222-1222.

Smoke Inhalation

Not all smoke inhalation victims will have cyanide poisoning and may present with burns, trauma, and exposure to other toxic substances making a diagnosis of cyanide poisoning particularly difficult. Prior to administration of Sodium Thiosulfate Injection smoke-inhalation victims should be assessed for the following:

Exposure to fire or smoke in an enclosed area
Presence of soot around the mouth, nose, or oropharynx
Altered mental status

Although hypotension is highly suggestive of cyanide poisoning, it is only present in a small percentage of cyanide-poisoned smoke inhalation victims. Also indicative of cyanide poisoning is a plasma lactate concentration greater than or equal to 10 mmol/L (a value higher than that typically listed in the table of signs and symptoms of isolated cyanide poisoning because carbon monoxide associated with smoke inhalation also contributes to lactic acidemia). If cyanide poisoning is suspected, treatment should not be delayed to obtain a plasma lactate concentration.
1.3 Use with Other Cyanide Antidotes

Caution should be exercised when administering cyanide antidotes, other than sodium nitrite, simultaneously with Sodium Thiosulfate Injection, as the safety of co-administration has not been established. If a decision is made to administer another cyanide antidote, other than sodium nitrite, with Sodium Thiosulfate Injection, these drugs should not be administered concurrently in the same IV line. [see Dosage and Administration (2.2)]
2 DOSAGE AND ADMINISTRATION
2.1 Administration Recommendation

Comprehensive treatment of acute cyanide intoxication requires support of vital functions. Administration of sodium nitrite and sodium thiosulfate should be considered adjunctive to appropriate supportive therapies. Airway, ventilatory and circulatory support, and oxygen administration should not be delayed to administer sodium nitrite and sodium thiosulfate.

Sodium nitrite injection and sodium thiosulfate injection are administered by slow intravenous injection. They should be given as early as possible after a diagnosis of acute life-threatening cyanide poisoning has been established. Sodium nitrite should be administered first, followed immediately by sodium thiosulfate. Blood pressure must be monitored during infusion in both adults and children. The rate of infusion should be decreased if significant hypotension is noted.
DOSAGE FORMS AND STRENGTHS

Sodium Thiosulfate Injection consists of:

One vial of sodium thiosulfate injection USP 12.5 grams/50 mL (250 mg/mL)

Administration of the contents of one vial constitutes a single dose.
CLINICAL PHARMACOLOGY
12.1 Mechanism of Action

Exposure to a high dose of cyanide can result in death within minutes due to the inhibition of cytochrome oxidase resulting in arrest of cellular respiration. Specifically, cyanide binds rapidly with cytochrome a3, a component of the cytochrome c oxidase complex in mitochondria. Inhibition of cytochrome a3 prevents the cell from using oxygen and forces anaerobic metabolism, resulting in lactate production, cellular hypoxia and metabolic acidosis. In massive acute cyanide poisoning, the mechanism of toxicity may involve other enzyme systems as well.

The synergy resulting from treatment of cyanide poisoning with the combination of sodium nitrite and sodium thiosulfate is the result of differences in their primary mechanisms of action as antidotes for cyanide poisoning.

Sodium Nitrite

Sodium nitrite is thought to exert its therapeutic effect by reacting with hemoglobin to form methemoglobin, an oxidized form of hemoglobin incapable of oxygen transport but with high affinity for cyanide. Cyanide preferentially binds to methemoglobin over cytochrome a3 , forming the nontoxic cyanomethemoglobin. Methemoglobin displaces cyanide from cytochrome oxidase, allowing resumption of aerobic metabolism. The chemical reaction is as follows:

NaNO2 + Hemoglobin → Methemoglobin

HCN + Methemoglobin → Cyanomethemoglobin

Vasodilation has also been cited to account for at least part of the therapeutic effect of sodium nitrite. It has been suggested that sodium nitrite-induced methemoglobinemia may be more efficacious against cyanide poisoning than comparable levels of methemoglobinemia induced by other oxidants. Also, sodium nitrite appears to retain some efficacy even when the formation of methemoglobin is inhibited by methylene blue.

Sodium Thiosulfate

The primary route of endogenous cyanide detoxification is by enzymatic transulfuration to thiocyanate (SCN-), which is relatively nontoxic and readily excreted in the urine. Sodium thiosulfate is thought to serve as a sulfur donor in the reaction catalyzed by the enzyme rhodanese, thus enhancing the endogenous detoxification of cyanide in the following chemical reaction:
Figure

NDC 60267-0705-50 UPC/GTIN No.3-60267-70550-7 Mfg.Part No.70550
RX ITEM-Sodium Thiosulfate 12.5G/50Ml Vi
NDC 60267-0705-50 UPC/GTIN No.3-60267-70550-7 Mfg.Part No.70550

BRAND: SODIUM THIOSULFATE NDC: 60267-0705-50,60267070550 UPC: 3-60267-70550-7,360267705507 Hope Pharmaceuticals
Sodium Thiosulfate 12.5G/50Ml Vial 50Ml
BRAND: SODIUM THIOSULFATE NDC: 60267-0705-50,60267070550 UPC: 3-60267-70550-7,360267705507 Hope Pharmaceuticals

Only Lic.-Physician,Pharmacy,Dentist,Drug Mfg,Dist.,Gov,Hospital,Lic.Lab,Naturalist,Naturopath,NP,Optometrist,Pharmacist,PA,Physical Therapist,Podiatrist,Research Co.,Uni.,VA,Vet & Wholesalers in scop
SODIUM THIOSULFATE INTRAV
Only Lic.-Physician,Pharmacy,Dentist,Drug Mfg,Dist.,Gov,Hospital,Lic.Lab,Naturalist,Naturopath,NP,Optometrist,Pharmacist,PA,Physical Therapist,Podiatrist,Research Co.,Uni.,VA,Vet & Wholesalers in scop

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Sodium Thiosulfate 12.5G/50ml Vial 50ml by Hope Pharma
Sodium Thiosulfate 12.5G/50ml
Sodium Thiosulfate 12.5G/50ml Vial 50ml by Hope Pharma