sodium thiosulfate at a glance
Medicine class
Antidote
Licensed roles
Cisplatin hearing protection in eligible paediatric patients; emergency treatment of life-threatening cyanide poisoning
How it is given
Into a vein by trained hospital staff
Monitoring
Blood pressure, kidney function and electrolytes may need monitoring
What is sodium thiosulfate used for?
Selected products have two distinct licensed uses.
Pedmarqsi is licensed to prevent hearing damage caused by cisplatin in patients aged 1 month to under 18 years with localised, non-metastatic solid tumours.
Sodium Thiosulfate Solution for Injection is licensed for sequential use with hydroxocobalamin or sodium nitrite in life-threatening acute cyanide poisoning.
How does sodium thiosulfate work?
In cyanide poisoning, it supplies sulfur that helps convert cyanide into less toxic thiocyanate, which can be passed in urine. Its hearing-protective mechanism is not fully established; proposed effects include reducing oxidative stress and reacting with cisplatin to form inactive platinum compounds.
sodium thiosulfate preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 80 mg/mL
How to take sodium thiosulfate
It is given into a vein by trained staff and is not self-administered. Pedmarqsi is ready to use and hypertonic; administration through a central vein is recommended. The cyanide-antidote formulation is given slowly with blood-pressure monitoring.
Solutions are inspected for particles or discolouration before use.
Each selected product is for single use.
With cisplatin, the oncology team controls timing because incorrect timing could reduce tumour-treatment efficacy or hearing protection.
The products are not interchangeable because their formulations and licensed purposes differ.
sodium thiosulfate side effects
Common or expected effects
- Nausea or vomiting
- Changes in blood sodium, potassium, phosphate or calcium
- Blood-pressure changes
- Headache or disorientation
- Salty taste or warm sensation
Get urgent medical advice
- Hypersensitivity with rash, breathing difficulty, chills or a fast heartbeat
- Severe low blood pressure with marked dizziness, fainting or collapse
- Clinically significant electrolyte imbalance or metabolic acidosis
- Unusual or prolonged bleeding
sodium thiosulfate in pregnancy
Pregnancy data are limited, and product information advises avoiding sodium thiosulfate as a precaution. In life-threatening cyanide poisoning, specialists weigh this uncertainty against the immediate danger of untreated poisoning. Pedmarqsi is used with cisplatin, which has separate pregnancy risks.
sodium thiosulfate while breastfeeding
It is unknown whether sodium thiosulfate enters human milk, and risk to a breastfed child cannot be excluded. Product information advises avoiding or discontinuing breastfeeding during treatment; specialist assessment is needed.
sodium thiosulfate interactions
Formal interaction studies are limited. Important administration relationships include:
Cisplatin
Administration must be carefully separated according to the authorised protocol. Incorrect timing may interfere with cisplatin’s antitumour effect or fail to protect hearing.
Hydroxocobalamin
For cyanide poisoning, do not administer simultaneously through the same intravenous line because chemical incompatibility may occur.
Sodium nitrite
This is a licensed sequential antidote partner. No chemical incompatibility has been reported when the products are administered sequentially through the same line.
Common questions about sodium thiosulfate
Answers are fully visible for fast scanning and source review.
Why is sodium thiosulfate given with cisplatin?
Pedmarqsi is licensed to reduce the risk of cisplatin-related hearing damage in eligible children and young people with localised, non-metastatic solid tumours.
Can it reverse hearing loss already caused by cisplatin?
It is licensed for prevention, not for reversing established hearing loss.
Is it an antidote for cyanide?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.