sodium thiosulfate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
sodium thiosulfate: clinical details
Prescribing considerations
- Confirm the intended licensed indication and select the matching formulation.
- For hearing protection, timing relative to cisplatin is critical.
- For suspected cyanide poisoning, antidotal treatment is adjunctive to immediate supportive care and appropriate decontamination.
- Account for the substantial sodium load, particularly with renal impairment, electrolyte disturbance or a controlled-sodium diet.
- Trace sulfite may cause hypersensitivity or bronchospasm, especially in people with asthma; emergency cyanide treatment should not be withheld solely because of sulfite sensitivity.
Contraindications and cautions
- Hypersensitivity to sodium thiosulfate or a formulation excipient.
- Pedmarqsi: preterm and term neonates younger than 1 month because of hypernatraemia risk.
Monitoring
- Blood pressure during administration.
- Serum sodium and other relevant electrolytes.
- Renal function, especially during cisplatin treatment or when impairment is present.
- Nausea, vomiting, hypersensitivity and bronchospasm.
- Clinical response and supportive-care requirements in cyanide poisoning.
Clinical pharmacology
Thiosulfate is distributed mainly through extracellular fluid and is eliminated substantially by renal filtration. In cyanide poisoning, it acts as a sulfur donor for conversion of cyanide to thiocyanate. Its hearing-protective actions may involve antioxidant effects and chemical inactivation of cisplatin species.
Formulation and product differences
- Pedmarqsi is a ready-to-use, hypertonic solution for infusion containing boric acid and substantial sodium; central venous administration is recommended.
- Sodium Thiosulfate Solution for Injection is a single-use cyanide-antidote formulation containing sodium, potassium and boric acid.
- Pedmarqsi must not be mixed with other medicines without compatibility evidence. The cyanide-antidote formulation must not share a line simultaneously with hydroxocobalamin.
sodium thiosulfate preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 80 mg/mL
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.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.