Page 133 - 2026 SMOG

HYDROXOCOBALAMIN (CYANOKIT)
Class/Mechanism of Action
• Antidote; Vitamin
Precursor to Vitamin B (cyanocobalamin). Binds cyanide ion to form nontoxic
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cyanocobalamin, which is excreted in urine.
Indications
• Labeled Indications
˚ IM: Treatment of pernicious anemia and B deficiencies
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®
˚ IV: (Cyanokit ) Treatment of known or suspected cyanide poisoning
Contraindications
• No contraindications when treating for suspected or known cyanide poisoning
Adverse Reactions/Precautions
• May cause transient hypertension (>180mmHg systolic, >110mmHg diastolic)
• Will cause persistent red colored urine and skin, acute renal injury, rendering pulse oximetry
values inaccurate
• Pregnancy: Use caution
• Lactation: Use caution
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Cyanide Poisonings Cyanide Poisonings (Off-Label)
Note: If cyanide poisoning is suspected, • IV/IO
antidotal therapy must be given immediately ˚ Initial: 70mg/kg (max dose: 5g) as a
• IV/IO single infusion given over 15min; Repeat
˚ Initial: 5g over 15min; Repeat a second a second dose of 70mg/kg based on
severity and clinical response
5g dose based on severity and clinical
response (max TOTAL dose: 10g) Smoke Inhalation/Fire victims (Closed Space
Smoke Inhalation/Fire victims (Closed Space Exposure with Evidence of Airway Injury: Soot
Exposure with Evidence of Airway Injury: Soot in Mouth/Nose/Sputum)
in Mouth/Nose/Sputum) • Cyanokit ®
• Cyanokit ® ˚ Preparation: Reconstitute each vial with
˚ Preparation: Reconstitute each vial with 200mL of NS (LR and D5W also OK).
Do not shake the vial (gently mix). Do not
200mL of NS (LR and D5W also OK).
Do not shake the vial (gently mix). Do not use if the solution is not dark red.
use if the solution is not dark red. Note: Patient may present with both
Note: Patient may present with both cyanide and carbon monoxide poisoning.
cyanide and carbon monoxide poisoning. Hydroxocobalamin is the agent of choice for
Hydroxocobalamin is the agent of choice for treating cyanide toxicity in this setting.
treating cyanide toxicity in this setting.

2026 Standard Medical Operating Guidelines (SMOG) • 125