{"id":"sodium-thiosulfate","rwe":[{"pmid":"41900016","year":"2026","title":"Biodegradation of Cyanide-Based Compounds by Rhodanese Produced from Kocuria rhizophila Under Submerged Fermentation and Its Role in Environmental Detoxification.","finding":"","journal":"Molecules (Basel, Switzerland)","studyType":"Clinical Study"},{"pmid":"41886707","year":"2026","title":"Use of Electronic Health Records to Benchmark Clinical Practice Guideline-Consistent Care in Pediatric Oncology.","finding":"","journal":"JCO clinical cancer informatics","studyType":"Clinical Study"},{"pmid":"41882263","year":"2026","title":"Protective Effect of Diuresis During Hyperthermia on Acute Kidney Injury in Cytoreductive Surgery with HIPEC.","finding":"","journal":"Annals of surgical oncology","studyType":"Clinical Study"},{"pmid":"41859426","year":"2026","title":"Sodium thiosulfate as a potential treatment for osteoma cutis in Albright hereditary osteodystrophy: A case report.","finding":"","journal":"JAAD case reports","studyType":"Clinical Study"},{"pmid":"41858936","year":"2026","title":"Occurrence modes of gold and relevant analytical methodologies.","finding":"","journal":"RSC advances","studyType":"Clinical Study"}],"_fda":{"id":"081d7623-9900-43fb-ad85-beb618555cdc","set_id":"82f55408-2de9-463d-85e8-b39c3b259f0b","openfda":{"unii":["HX1032V43M"],"route":["INTRAVENOUS"],"rxcui":["237832"],"spl_id":["081d7623-9900-43fb-ad85-beb618555cdc"],"brand_name":["Sodium Thiosulfate"],"spl_set_id":["82f55408-2de9-463d-85e8-b39c3b259f0b"],"package_ndc":["60267-705-50"],"product_ndc":["60267-705"],"generic_name":["SODIUM THIOSULFATE"],"product_type":["HUMAN PRESCRIPTION DRUG"],"substance_name":["SODIUM THIOSULFATE"],"manufacturer_name":["Hope Pharmaceuticals"],"application_number":["NDA203923"],"is_original_packager":[true]},"version":"14","pregnancy":["8.1 Pregnancy Risk Summary There are no available data on Sodium Thiosulfate Injection use in pregnant women to establish a drug-associated risk for major birth defects, miscarriage, or adverse maternal or fetal outcomes. There are risks to the pregnant woman and fetus associated with untreated cyanide poisoning (see Clinical Considerations ). Therefore, if a pregnant woman has known or suspected cyanide poisoning, Sodium Thiosulfate Injection for sequential use with sodium nitrite is recommended [see Indications and Usage (1) ] . In published animal studies, no evidence of embryotoxicity or malformations was reported when sodium thiosulfate was administered during organogenesis to pregnant mice, rats, hamsters, or rats at 0.2 to 0.9 times the human daily dose of 12.5 g for cyanide poisoning. The studies did not test doses that were comparable to the human dose for cyanide poisoning (see Data ). The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the US general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. Clinical Considerations Disease-associated maternal and/or embryo/fetal risk Cyanide readily crosses the placenta. Cyanide poisoning is a medical emergency in pregnancy, which can be fatal for the pregnant woman and fetus if left untreated. Life-sustaining therapy should not be withheld due to pregnancy. Data Animal Data: No malformations or evidence of embryo-fetal toxicity were noted when pregnant mice, rats, hamsters, or rabbits were administered oral doses of sodium thiosulfate of up to 550, 400, 400, or 580 mg/kg, respectively during organogenesis (0.2, 0.3, 0.26, and 0.9 times the human dose of 12.5 g/60 kg person for cyanide poisoning based on body surface area). Published studies suggest that treatment with sodium thiosulfate ameliorates the teratogenic effects of maternal cyanide poisoning in hamsters."],"overdosage":["10 OVERDOSAGE There is limited information about the effects of large doses of sodium thiosulfate in humans. Oral administration of 3 g sodium thiosulfate per day for 1-2 weeks in humans resulted in reductions in room air arterial oxygen saturation to as low as 75%, which was due to a rightward shift in the oxygen hemoglobin dissociation curve. The subjects returned to baseline oxygen saturations 1 week after discontinuation of sodium thiosulfate. A single intravenous administration of 20 mL of 10% sodium thiosulfate reportedly did not change oxygen saturations."],"description":["11 DESCRIPTION Sodium thiosulfate has the chemical name thiosulfuric acid, disodium salt, pentahydrate. The chemical formula is Na 2 S 2 O 3 ∙ 5H 2 O and the molecular weight is 248.17. The structural formula is: Structure of Sodium Thiosulfate Pentahydrate Sodium Thiosulfate Injection is a cyanide antidote which contains one 50 mL glass vial containing a 25% solution of sodium thiosulfate injection. Sodium thiosulfate injection is a sterile aqueous solution and is intended for intravenous injection. Each vial contains 12.5 grams of sodium thiosulfate in 50 mL solution (250 mg/mL). Each mL also contains 2.8 mg boric acid and 4.4 mg of potassium chloride. The pH of the solution is adjusted with boric acid and/or sodium hydroxide. Sodium thiosulfate injection is a clear solution with a pH between 7.5 and 9.0. Chemical Structure"],"how_supplied":["16 HOW SUPPLIED/STORAGE AND HANDLING Each Sodium Thiosulfate carton (NDC 60267-705-50) consists of the following: One 50 mL glass vial of sodium thiosulfate injection 250 mg/mL (containing 12.5 grams of sodium thiosulfate); Storage Store at controlled room temperature between 20°C and 25°C (68°F to 77°F); excursions permitted from 15 to 30°C (59 to 86°F). Protect from direct light. Do not freeze. (Note: Sodium Nitrite must be obtained separately.)"],"geriatric_use":["8.5 Geriatric Use Sodium thiosulfate is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function."],"pediatric_use":["8.4 Pediatric Use There are case reports in the medical literature of sodium nitrite in conjunction with sodium thiosulfate being administered to pediatric patients with cyanide poisoning; however, there have been no clinical studies to evaluate the safety or efficacy of sodium thiosulfate in the pediatric population. As for adult patients, dosing recommendations for pediatric patients have been based on theoretical calculations of antidote detoxifying potential, extrapolation from animal experiments, and a small number of human case reports."],"effective_time":"20251006","clinical_studies":["14 CLINICAL STUDIES Human Data The human data supporting the use of sodium thiosulfate for cyanide poisoning consists primarily of published case reports. There are no randomized controlled clinical trials. Nearly all the human data describing the use of sodium thiosulfate report its use in conjunction with sodium nitrite. Dosing recommendations for humans have been based on theoretical calculations of antidote detoxifying potential, extrapolation from animal experiments, and a small number of human case reports. There have been no human studies to prospectively and systematically evaluate the safety of sodium thiosulfate or sodium nitrite in humans. Available human safety information is based largely on anecdotal case reports and case series of limited scope. Animal Data (Cyanide Poisoning) THE EFFECTIVENESS OF SODIUM THIOSULFATE AND SODIUM NITRITE FOR THE TREATMENT OF ACUTE CYANIDE POISONING HAS NOT BEEN STUDIED IN HUMANS IN ADEQUATE AND WELL-CONTROLLED CLINICAL TRIALS BECAUSE INDUCING THE CONDITION IN HUMANS TO STUDY THE DRUG'S EFFICACY IS NOT ETHICAL. Due to the extreme toxicity of cyanide, experimental evaluation of treatment efficacy has predominantly been completed in animal models. The efficacy of sodium thiosulfate treatment alone to counteract the toxicity of cyanide was initially reported in 1895 by Lang. The efficacy of amyl nitrite treatment in cyanide poisoning of the dog model was first reported in 1888 by Pedigo. Further studies in the dog model, which demonstrated the utility of sodium nitrite as a therapeutic intervention, were reported in 1929 by Mladoveanu and Gheorghiu. However, Hugs and Chen et al. independently reported upon the superior efficacy of the combination of sodium nitrite and sodium thiosulfate in 1932-1933. Treatment consisted of intravenously administered 22.5 mg/kg (half the lethal dose) sodium nitrite or 1 g/kg sodium thiosulfate alone or in sequence immediately after subcutaneous injection of sodium cyanide into dogs over a range of doses. Subsequent doses of 10 mg/kg sodium nitrite and/or 0.5 g/kg sodium thiosulfate were administered when clinical signs or symptoms of poisoning persisted or reappeared. Either therapy administered alone increased the dose of sodium cyanide required to cause death, and when administered together, sodium nitrite and sodium thiosulfate resulted in a synergistic effect in raising the lethal dose of sodium cyanide. The combined therapy appeared to have reduced efficacy when therapy was delayed until signs of poisoning (e.g. convulsions) appeared; however, other investigators have reported survival in dogs that were administered antidotal treatment after respiratory arrest had occurred. Animal studies conducted in other species (e.g., rat, guinea pig, sheep, pigeon and cat) have also supported a synergistic effect of intravenous sodium nitrite and sodium thiosulfate in the treatment of cyanide poisoning. While intravenous injection of sodium nitrite and sodium thiosulfate was effective in reversing the effects of lethal doses of cyanide in dogs, intramuscular injection of sodium nitrite, with or without sodium thiosulfate, was found not to be effective in the same setting."],"pharmacodynamics":["12. 2 Pharmacodynamics In dogs, pretreatment with sodium thiosulfate to achieve a steady state level of 2 μmol/mL increased the rate of conversion of cyanide to thiocyanate over 30-fold."],"pharmacokinetics":["12.3 Pharmacokinetics Sodium Thiosulfate Thiosulfate taken orally is not systemically absorbed. Most of the thiosulfate is oxidized to sulfate or is incorporated into endogenous sulphur compounds; a small proportion is excreted through the kidneys. Approximately 20-50% of exogenously administered thiosulfate is eliminated unchanged via the kidneys. After an intravenous injection of 1 g sodium thiosulfate in patients, the reported serum thiosulfate half-life was approximately 20 minutes. However, after an intravenous injection of a substantially higher dose of sodium thiosulfate (150 mg/kg, that is, 9 g for 60 kg body weight) in normal healthy men, the reported elimination half-life was 182 minutes. Cyanide The apparent terminal elimination half life and volume of distribution of cyanide, in a patient treated for an acute cyanide poisoning with sodium nitrite and sodium thiosulfate administration, have been reported to be 19 hours and 0.41 L/kg, respectively. Additionally, an initial elimination half life of cyanide has been reported to be approximately 1-3 hours. Thiocyanate After detoxification, in healthy subjects, thiocyanate is excreted mainly in the urine at a rate inversely proportional to creatinine clearance. In healthy subjects, the elimination half-life and volume of distribution of thiocyanate have been reported to be 2.7 days and 0.25 L/kg, respectively. However, in subjects with renal insufficiency the reported elimination half life is approximately 9 days."],"adverse_reactions":["6 ADVERSE REACTIONS There have been no controlled clinical trials conducted to systematically assess the adverse events profile of sodium thiosulfate. The medical literature has reported the following adverse events in association with sodium thiosulfate administration. These adverse events were not reported in the context of controlled trials or with consistent monitoring and reporting methodologies for adverse events. Therefore, frequency of occurrence of these adverse events cannot be assessed. Cardiovascular system: hypotension Central nervous system: headache, disorientation Gastrointestinal system: nausea, vomiting Hematological : prolonged bleeding time Body as a Whole: salty taste in mouth, warm sensation over body In humans, rapid administration of concentrated solutions or solutions not freshly prepared, and administration of large doses of sodium thiosulfate have been associated with a higher incidence of nausea and vomiting. However, administration of 0.1 g sodium thiosulfate per pound up to a maximum of 15 g in a 10-15% solution over 10-15 minutes was associated with nausea and vomiting in 7 of 26 patients without concomitant cyanide intoxication. In a series of 11 human subjects, a single intravenous infusion of 50 mL of 50% sodium thiosulfate was associated with increases in clotting time 1-3 days after administration. However, no significant changes were observed in other hematological parameters. Most common adverse reactions are: Hypotension, headache, disorientation ( 6 ) To report SUSPECTED ADVERSE REACTIONS, contact Hope Pharmaceuticals at 1-800-755-9595 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch ."],"contraindications":["4 CONTRAINDICATIONS None None. ( 4 )"],"drug_interactions":["7 DRUG INTERACTIONS Formal drug interaction studies have not been conducted with Sodium Thiosulfate Injection."],"mechanism_of_action":["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 a 3 , forming the nontoxic cyanomethemoglobin. Methemoglobin displaces cyanide from cytochrome oxidase, allowing resumption of aerobic metabolism. The chemical reaction is as follows: NaNO 2 + 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: Rhodanese Na 2 S 2 O 3 + CN - → SCN - + Na 2 SO 3 ."],"storage_and_handling":["Storage Store at controlled room temperature between 20°C and 25°C (68°F to 77°F); excursions permitted from 15 to 30°C (59 to 86°F). Protect from direct light. Do not freeze. (Note: Sodium Nitrite must be obtained separately.)"],"clinical_pharmacology":["12 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 a 3 , forming the nontoxic cyanomethemoglobin. Methemoglobin displaces cyanide from cytochrome oxidase, allowing resumption of aerobic metabolism. The chemical reaction is as follows: NaNO 2 + 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: Rhodanese Na 2 S 2 O 3 + CN - → SCN - + Na 2 SO 3 . 12. 2 Pharmacodynamics In dogs, pretreatment with sodium thiosulfate to achieve a steady state level of 2 μmol/mL increased the rate of conversion of cyanide to thiocyanate over 30-fold. 12.3 Pharmacokinetics Sodium Thiosulfate Thiosulfate taken orally is not systemically absorbed. Most of the thiosulfate is oxidized to sulfate or is incorporated into endogenous sulphur compounds; a small proportion is excreted through the kidneys. Approximately 20-50% of exogenously administered thiosulfate is eliminated unchanged via the kidneys. After an intravenous injection of 1 g sodium thiosulfate in patients, the reported serum thiosulfate half-life was approximately 20 minutes. However, after an intravenous injection of a substantially higher dose of sodium thiosulfate (150 mg/kg, that is, 9 g for 60 kg body weight) in normal healthy men, the reported elimination half-life was 182 minutes. Cyanide The apparent terminal elimination half life and volume of distribution of cyanide, in a patient treated for an acute cyanide poisoning with sodium nitrite and sodium thiosulfate administration, have been reported to be 19 hours and 0.41 L/kg, respectively. Additionally, an initial elimination half life of cyanide has been reported to be approximately 1-3 hours. Thiocyanate After detoxification, in healthy subjects, thiocyanate is excreted mainly in the urine at a rate inversely proportional to creatinine clearance. In healthy subjects, the elimination half-life and volume of distribution of thiocyanate have been reported to be 2.7 days and 0.25 L/kg, respectively. However, in subjects with renal insufficiency the reported elimination half life is approximately 9 days."],"indications_and_usage":["1 INDICATIONS AND USAGE Sodium Thiosulfate Injection is indicated for sequential use with sodium nitrite for the treatment of acute cyanide poisoning that is judged to be serious or 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. Sodium Thiosulfate Injection, an antidote, is indicated for sequential use with sodium nitrite for treatment of acute cyanide poisoning that is judged to be serious or life-threatening. ( 1 ) Use with caution if the diagnosis of cyanide poisoning is uncertain. ( 1 )"],"warnings_and_cautions":["5 WARNINGS AND PRECAUTIONS Sulfites: Sodium thiosulfate may contain trace impurities of sodium sulfite ( 5.1 ) 5.1 Sulfites Sodium thiosulfate drug product may contain trace impurities of sodium sulfite. The presence of a trace amount of sulfites in this product should not deter administration of the drug for treatment of emergency situations, even if the patient is sulfite-sensitive."],"nonclinical_toxicology":["13 NONCLINICAL TOXICOLOGY 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenesis Long-term studies in animals have not been performed to evaluate the potential carcinogenicity of sodium thiosulfate. Mutagenesis: The mutagenic potential of sodium thiosulfate has been examined in the in vitro Bacterial Reverse Mutation Assay (Ames Assay). Sodium thiosulfate was not mutagenic in the absence of metabolic activation in S. typhimurium strains TA98, TA100, TA1535, TA537, or TA1538. Sodium thiosulfate was not mutagenic in the presence of metabolic activation in strains TA 98, TA1535, TA1537, TA1538 or E. coli strain WP2. Sodium thiosulfate was negative for clastogenic potential in the in vivo mammalian erythrocyte micronucleus assay in rats. Impairment of Fertility : Animal studies to examine the effects of sodium thiosulfate on fertility have not been conducted."],"information_for_patients":["17 PATIENT COUNSELING INFORMATION Sodium Thiosulfate Injection is indicated for cyanide poisoning and in this setting, patients will likely be unresponsive or may have difficulty in comprehending counseling information. Hypotension When feasible, patients should be informed of the possibility of hypotension. Monitoring Where feasible, patients should be informed of the need for close monitoring of blood pressure and oxygenation. Lactation Advise women that breastfeeding is not recommended during treatment with Sodium Thiosulfate Injection [see Use in Specific Populations (8.2) ]."],"spl_unclassified_section":["Hope Pharmaceuticals, Scottsdale, Arizona 85260 US PATENTS 8496973, 9345724, and 9585912"],"dosage_and_administration":["2. DOSAGE AND ADMINISTRATION If clinical suspicion of cyanide poisoning is high, administer Sodium Thiosulfate Injection without delay and in conjunction with appropriate airway, ventilatory, and circulatory support. ( 2.1 ) The expert advice of a regional poison control center may be obtained by calling 1-800-222-1222. ( 2.1 ) Dosing : Age Intravenous Dose of Sodium Nitrite and Sodium Thiosulfate Adults 1.) Sodium Nitrite -10 mL of sodium nitrite at the rate of 2.5 to 5 mL/minute 2.) Sodium Thiosulfate - 50 mL of sodium thiosulfate immediately following administration of sodium nitrite. Children 1.) Sodium Nitrite - 0.2 mL/kg (6 mg/kg or 6-8 mL/m 2 BSA) of sodium nitrite at the rate of 2.5 to 5 mL/minute not to exceed 10 mL 2.) Sodium Thiosulfate - 1 mL/kg of body weight (250 mg/kg or approximately 30-40 mL/m 2 of BSA) not to exceed 50 mL total dose immediately following administration of sodium nitrite. Redosing : If signs of cyanide poisoning reappear, repeat treatment using one-half the original dose of both sodium nitrite and sodium thiosulfate. ( 2.2 ) Monitoring : Blood pressure must be monitored during treatment. ( 2.2 ) Sodium thiosulfate is chemically incompatible with hydroxocobalamin and should not be administered via the same intravenous line. (2.4) 2.1 Important Dosage and Administration Instructions If clinical suspicion of cyanide poisoning is high, administer Sodium Thiosulfate Injection without delay. 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 in order to administer sodium nitrite and sodium thiosulfate [see Warnings and Precautions (5.1) ] . The expert advice of a regional poison control center may be obtained by calling 1-800-222-1222. 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. 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. 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 in order to obtain a plasma lactate concentration. Use with Other Cyanide Antidotes The safety of administering other cyanide antidotes simultaneously with Sodium Thiosulfate Injection has not been established. If a decision is made to administer another cyanide antidote with Sodium Thiosulfate Injection, these drugs should not be administered concurrently in the same intravenous (IV) line. [see Dosage and Administration (2.2) ] 2.2 Recommended Dosing 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. Age Intravenous Dose of Sodium Nitrite and Sodium Thiosulfate Adults 1.) Sodium Nitrite -10 mL of sodium nitrite at the rate of 2.5 to 5 mL/minute 2.) Sodium Thiosulfate - 50 mL of sodium thiosulfate immediately following administration of sodium nitrite. Children 1.) Sodium Nitrite - 0.2 mL/kg (6 mg/kg or 6-8 mL/m 2 BSA) of sodium nitrite at the rate of 2.5 to 5 mL/minute not to exceed 10 mL 2.) Sodium Thiosulfate - 1 mL/kg of body weight (250 mg/kg or approximately 30-40 mL/m 2 of BSA) not to exceed 50 mL total dose immediately following administration of sodium nitrite. NOTE: If signs of poisoning reappear, repeat treatment using one-half the original dose of both sodium nitrite and sodium thiosulfate. In adult and pediatric patients with known anemia, it is recommended that the dosage of sodium nitrite should be reduced proportionately to the hemoglobin concentration. Visually inspect all parenteral drug products for particulate matter and discoloration prior to administration. 2.3 Recommended Monitoring Patients should be monitored for at least 24-48 hours after Sodium Thiosulfate Injection administration for adequacy of oxygenation and perfusion and for recurrent signs and symptoms of cyanide toxicity. When possible, obtain hemoglobin/hematocrit when treatment is initiated. Measurements of oxygen saturation using standard pulse oximetry and calculated oxygen saturation values based on measured PO 2 are unreliable in the presence of methemoglobinemia. 2.4 Incompatibility Information Chemical incompatibility has been reported between Sodium Thiosulfate Injection and hydroxocobalamin and these drugs should not be administered simultaneously through the same IV line. No chemical incompatibility has been reported between sodium thiosulfate and sodium nitrite, when administered sequentially through the same IV line as described in Dosage and Administration. Simultaneous administration of Sodium Thiosulfate Injection and blood products (whole blood, packed red cells, platelet concentrate and/or fresh frozen plasma) through the same intravenous line is not recommended. However, blood products and Sodium Thiosulfate Injection can be administered simultaneously using separate intravenous lines (preferably on contralateral extremities, if peripheral lines are being used)."],"mechanism_of_action_table":["<table width=\"40%\" styleCode=\"Noautorules\"><col width=\"100%\" align=\"center\" valign=\"top\"/><tbody><tr><td>Rhodanese</td></tr><tr><td>Na<sub>2</sub>S<sub>2</sub>O<sub>3</sub> + CN<sup>-</sup> &#x2192; SCN<sup>-</sup> + Na<sub>2</sub>SO<sub>3</sub>.</td></tr></tbody></table>"],"spl_product_data_elements":["Sodium Thiosulfate Sodium Thiosulfate Sodium Thiosulfate THIOSULFATE ION Potassium Chloride Boric Acid Water Sodium Hydroxide Nitrogen"],"dosage_forms_and_strengths":["3 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 one vial constitutes a single dose. Sodium Thiosulfate Injection consists of: One vial of sodium thiosulfate injection USP 12.5 grams/50 mL (250 mg/mL) ( 3 )"],"clinical_pharmacology_table":["<table width=\"40%\" styleCode=\"Noautorules\"><col width=\"100%\" align=\"center\" valign=\"top\"/><tbody><tr><td>Rhodanese</td></tr><tr><td>Na<sub>2</sub>S<sub>2</sub>O<sub>3</sub> + CN<sup>-</sup> &#x2192; SCN<sup>-</sup> + Na<sub>2</sub>SO<sub>3</sub>.</td></tr></tbody></table>"],"use_in_specific_populations":["8 USE IN SPECIFIC POPULATIONS Lactation : Breastfeeding not recommended. ( 8.2 ) Renal impairment : Sodium thiosulfate is substantially excreted by the kidney. The risk of toxic reactions to this drug may be greater in patients with impaired renal function. ( 8.6 ). 8.1 Pregnancy Risk Summary There are no available data on Sodium Thiosulfate Injection use in pregnant women to establish a drug-associated risk for major birth defects, miscarriage, or adverse maternal or fetal outcomes. There are risks to the pregnant woman and fetus associated with untreated cyanide poisoning (see Clinical Considerations ). Therefore, if a pregnant woman has known or suspected cyanide poisoning, Sodium Thiosulfate Injection for sequential use with sodium nitrite is recommended [see Indications and Usage (1) ] . In published animal studies, no evidence of embryotoxicity or malformations was reported when sodium thiosulfate was administered during organogenesis to pregnant mice, rats, hamsters, or rats at 0.2 to 0.9 times the human daily dose of 12.5 g for cyanide poisoning. The studies did not test doses that were comparable to the human dose for cyanide poisoning (see Data ). The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the US general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. Clinical Considerations Disease-associated maternal and/or embryo/fetal risk Cyanide readily crosses the placenta. Cyanide poisoning is a medical emergency in pregnancy, which can be fatal for the pregnant woman and fetus if left untreated. Life-sustaining therapy should not be withheld due to pregnancy. Data Animal Data: No malformations or evidence of embryo-fetal toxicity were noted when pregnant mice, rats, hamsters, or rabbits were administered oral doses of sodium thiosulfate of up to 550, 400, 400, or 580 mg/kg, respectively during organogenesis (0.2, 0.3, 0.26, and 0.9 times the human dose of 12.5 g/60 kg person for cyanide poisoning based on body surface area). Published studies suggest that treatment with sodium thiosulfate ameliorates the teratogenic effects of maternal cyanide poisoning in hamsters. 8.2 Lactation Risk Summary There are no data on the presence of sodium thiosulfate in human or animal milk, the effects on the breastfed infant, or the effects on milk production. Cyanide and thiocyanate (which is formed when sodium thiosulfate combines with cyanide) are present in human milk. Because of the potential for serious adverse reactions in the breastfed infant, breastfeeding is not recommended during treatment with Sodium Thiosulfate Injection. There are no data to determine when breastfeeding may be safely restarted following the administration of Sodium Thiosulfate Injection. 8.4 Pediatric Use There are case reports in the medical literature of sodium nitrite in conjunction with sodium thiosulfate being administered to pediatric patients with cyanide poisoning; however, there have been no clinical studies to evaluate the safety or efficacy of sodium thiosulfate in the pediatric population. As for adult patients, dosing recommendations for pediatric patients have been based on theoretical calculations of antidote detoxifying potential, extrapolation from animal experiments, and a small number of human case reports. 8.5 Geriatric Use Sodium thiosulfate is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. 8.6 Renal Disease Sodium thiosulfate is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function."],"dosage_and_administration_table":["<table width=\"100%\"><col width=\"20%\" align=\"left\" valign=\"top\"/><col width=\"80%\" align=\"left\" valign=\"top\"/><thead><tr><th styleCode=\"Lrule Rrule\"> Age</th><th styleCode=\"Rrule\">Intravenous Dose of Sodium Nitrite and Sodium Thiosulfate</th></tr></thead><tbody><tr><td styleCode=\"Lrule Rrule\"><content styleCode=\"bold\">Adults</content></td><td styleCode=\"Rrule\"><list listType=\"unordered\"><item><caption styleCode=\"bold\">1.)</caption><content styleCode=\"bold\">Sodium Nitrite</content> -10 mL of sodium nitrite at the rate of 2.5 to 5 mL/minute</item><item><caption styleCode=\"bold\">2.)</caption><content styleCode=\"bold\">Sodium Thiosulfate</content> - 50 mL of sodium thiosulfate immediately following administration of sodium nitrite.</item></list></td></tr><tr><td styleCode=\"Lrule Rrule\"><content styleCode=\"bold\">Children </content></td><td styleCode=\"Rrule\"><list listType=\"unordered\"><item><caption styleCode=\"bold\">1.)</caption><content styleCode=\"bold\">Sodium Nitrite - </content>0.2 mL/kg (6 mg/kg or 6-8 mL/m<sup>2</sup> BSA) of sodium nitrite at the rate of 2.5 to 5 mL/minute not to exceed 10 mL</item><item><caption styleCode=\"bold\">2.)</caption><content styleCode=\"bold\">Sodium Thiosulfate - </content>1 mL/kg of body weight (250 mg/kg or approximately 30-40 mL/m<sup>2</sup> of BSA) not to exceed 50 mL total dose immediately following administration of sodium nitrite.</item></list></td></tr></tbody></table>","<table width=\"65%\"><caption>Table 1. Common Signs and Symptoms of Cyanide Poisoning</caption><col width=\"35%\" align=\"left\" valign=\"top\"/><col width=\"65%\" align=\"left\" valign=\"top\"/><thead><tr><th styleCode=\"Lrule Rrule\">Symptoms</th><th styleCode=\"Rrule\">Signs</th></tr></thead><tbody><tr><td styleCode=\"Lrule Rrule\"><list listType=\"unordered\" styleCode=\"Disc\"><item>Headache</item><item>Confusion</item><item>Dyspnea</item><item>Chest Tightness</item><item>Nausea</item></list></td><td styleCode=\"Rrule\"><list listType=\"unordered\" styleCode=\"Disc\"><item>Altered Mental Status (e.g., confusion, disorientation)</item><item>Seizures or Coma</item><item>Mydriasis</item><item>Tachypnea/Hyperpnea (early)</item><item>Bradypnea/Apnea (late)</item><item>Hypertension (early)/ Hypotension (late)</item><item>Cardiovascular Collapse</item><item>Vomiting</item><item>Plasma Lactate Concentration &#x2265; 8 mmol/L</item></list></td></tr></tbody></table>","<table width=\"75%\"><col width=\"20%\" align=\"left\" valign=\"top\"/><col width=\"80%\" align=\"left\" valign=\"top\"/><thead><tr><th styleCode=\"Lrule Rrule\"> Age</th><th styleCode=\"Rrule\">Intravenous Dose of Sodium Nitrite and Sodium Thiosulfate</th></tr></thead><tbody><tr><td styleCode=\"Lrule Rrule\"><content styleCode=\"bold\">Adults</content></td><td styleCode=\"Rrule\"><list listType=\"unordered\"><item><caption styleCode=\"bold\">1.)</caption><content styleCode=\"bold\">Sodium Nitrite</content> -10 mL of sodium nitrite at the rate of 2.5 to 5 mL/minute</item><item><caption styleCode=\"bold\">2.)</caption><content styleCode=\"bold\">Sodium Thiosulfate</content> - 50 mL of sodium thiosulfate immediately following administration of sodium nitrite.</item></list></td></tr><tr><td styleCode=\"Lrule Rrule\"><content styleCode=\"bold\">Children </content></td><td styleCode=\"Rrule\"><list listType=\"unordered\"><item><caption styleCode=\"bold\">1.)</caption><content styleCode=\"bold\">Sodium Nitrite -</content>0.2 mL/kg (6 mg/kg or 6-8 mL/m<sup>2</sup> BSA) of sodium nitrite at the rate of 2.5 to 5 mL/minute not to exceed 10 mL</item><item><caption styleCode=\"bold\">2.)</caption><content styleCode=\"bold\">Sodium Thiosulfate - </content>1 mL/kg of body weight (250 mg/kg or approximately 30-40 mL/m<sup>2</sup> of BSA) not to exceed 50 mL total dose immediately following administration of sodium nitrite.</item></list></td></tr></tbody></table>"],"package_label_principal_display_panel":["PRINCIPAL DISPLAY PANEL - 50 mL Vial Carton NDC 60267-705-50 Rx Only Sodium Thiosulfate Injection, USP 12.5 grams/50 mL (250 mg/mL) FOR INTRAVENOUS USE SINGLE DOSE ONLY Any unused portion of a vial should be discarded. Use with Sodium Nitrite for Treatment of Cyanide Poisoning Manufactured for: HOPE PHARMACEUTICALS ™ Scottsdale, AZ 85260 U.S.A. PRINCIPAL DISPLAY PANEL - 50 mL Vial Carton"],"carcinogenesis_and_mutagenesis_and_impairment_of_fertility":["13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenesis Long-term studies in animals have not been performed to evaluate the potential carcinogenicity of sodium thiosulfate. Mutagenesis: The mutagenic potential of sodium thiosulfate has been examined in the in vitro Bacterial Reverse Mutation Assay (Ames Assay). Sodium thiosulfate was not mutagenic in the absence of metabolic activation in S. typhimurium strains TA98, TA100, TA1535, TA537, or TA1538. Sodium thiosulfate was not mutagenic in the presence of metabolic activation in strains TA 98, TA1535, TA1537, TA1538 or E. coli strain WP2. Sodium thiosulfate was negative for clastogenic potential in the in vivo mammalian erythrocyte micronucleus assay in rats. Impairment of Fertility : Animal studies to examine the effects of sodium thiosulfate on fertility have not been conducted."]},"tags":[{"label":"sodium thiosulfate","category":"class"},{"label":"Small Molecule","category":"modality"},{"label":"Intravenous","category":"route"},{"label":"Injection","category":"form"},{"label":"Off-Patent","category":"patent"},{"label":"Active","category":"status"},{"label":"Reduce the risk of ototoxicity associated with cisplatin","category":"indication"},{"label":"Toxic effect of cyanide","category":"indication"},{"label":"Us Army","category":"company"},{"label":"Approved 1990s","category":"decade"},{"label":"Anti-Bacterial Agents","category":"pharmacology"},{"label":"Anti-Infective Agents","category":"pharmacology"},{"label":"Antidotes","category":"pharmacology"},{"label":"Antioxidants","category":"pharmacology"},{"label":"Antitubercular Agents","category":"pharmacology"},{"label":"Chelating Agents","category":"pharmacology"},{"label":"Protective Agents","category":"pharmacology"},{"label":"Sequestering Agents","category":"pharmacology"}],"phase":"marketed","safety":{"boxedWarnings":[],"safetySignals":[{"date":"","signal":"OFF LABEL USE","source":"FDA FAERS","actionTaken":"129 reports"},{"date":"","signal":"CALCIPHYLAXIS","source":"FDA FAERS","actionTaken":"85 reports"},{"date":"","signal":"NAUSEA","source":"FDA FAERS","actionTaken":"68 reports"},{"date":"","signal":"DRUG INEFFECTIVE","source":"FDA FAERS","actionTaken":"51 reports"},{"date":"","signal":"VOMITING","source":"FDA FAERS","actionTaken":"47 reports"},{"date":"","signal":"METABOLIC ACIDOSIS","source":"FDA FAERS","actionTaken":"29 reports"},{"date":"","signal":"SEPSIS","source":"FDA FAERS","actionTaken":"22 reports"},{"date":"","signal":"CONDITION AGGRAVATED","source":"FDA FAERS","actionTaken":"21 reports"},{"date":"","signal":"DEATH","source":"FDA FAERS","actionTaken":"17 reports"},{"date":"","signal":"PRURITUS","source":"FDA FAERS","actionTaken":"17 reports"}],"commonSideEffects":[{"effect":"Hypotension","drugRate":"6%","severity":"common","_validated":true},{"effect":"Headache","drugRate":"6%","severity":"common","_validated":true},{"effect":"Disorientation","drugRate":"6%","severity":"common","_validated":true}],"contraindications":["Blister","Condyloma acuminatum","Diabetes mellitus","Infection of skin AND/OR subcutaneous tissue","Inflammatory dermatosis","Methemoglobinemia","Peripheral vascular disease","Skin irritation"],"specialPopulations":{"Pregnancy":"There are no available data on PEDMARK used in pregnant women to evaluate for drug-associated risk. PEDMARK is administered following cisplatin infusions, which can cause embryo-fetal harm. Refer to cisplatin prescribing information for additional information. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. There are no data on the presence of sodium thiosulfate in human or animal milk, the effects on the breastfed infant, or the effects on milk production. Cyanide and thiocyanate (which is formed when sodium thiosulfate combines with cyanide) are present in human milk. Because of the potential for serious adverse reactions in the breastfed infant, breastfeeding is not recommended during treatment with Sodium Thiosulfate Injection. There are no data to determine when breastfeeding can be safely resumed.","Geriatric use":"Sodium thiosulfate is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.","Paediatric use":"There are case reports in the medical literature of sodium nitrite in conjunction with sodium thiosulfate being administered to pediatric patients with cyanide poisoning; however, there have been no clinical studies to evaluate the safety or efficacy of sodium thiosulfate in the pediatric population. As for adult patients, dosing recommendations for pediatric patients have been based on theoretical calculations of antidote detoxifying potential, extrapolation from animal experiments, and clinical experience.","Renal impairment":"Monitor for signs and symptoms of hypernatremia and hypokalemia more closely if the glomerular filtration rate (GFR) falls below 60 mL/min/1.73m2."}},"trials":[],"aliases":[],"company":"Us Army","patents":[{"type":"Compound","number":"9345724","applicant":"HOPE PHARMACEUTICALS","territory":"US","tradeName":"SODIUM THIOSULFATE","expiryDate":"2030-07-07"},{"type":"Compound","number":"8496973","applicant":"HOPE PHARMACEUTICALS","territory":"US","tradeName":"SODIUM THIOSULFATE","expiryDate":"2031-03-29"},{"type":"Method of Use","number":"11998604","applicant":"FENNEC PHARMACEUTICALS INC","territory":"US","tradeName":"PEDMARK","expiryDate":"2039-07-01"},{"type":"Method of Use","number":"11992530","applicant":"FENNEC PHARMACEUTICALS INC","territory":"US","tradeName":"PEDMARK","expiryDate":"2039-07-01"},{"type":"Method of Use","number":"11964018","applicant":"FENNEC PHARMACEUTICALS INC","territory":"US","tradeName":"PEDMARK","expiryDate":"2039-07-01"},{"type":"Formulation","number":"10479686","applicant":"HOPE PHARMACEUTICALS","territory":"US","tradeName":"SODIUM THIOSULFATE","expiryDate":"2030-07-07"},{"type":"Compound","number":"11753301","applicant":"HOPE PHARMACEUTICALS","territory":"US","tradeName":"SODIUM THIOSULFATE","expiryDate":"2030-02-10"},{"type":"Method of Use","number":"10596190","applicant":"FENNEC PHARMACEUTICALS INC","territory":"US","tradeName":"PEDMARK","expiryDate":"2038-01-05"},{"type":"Formulation","number":"11617793","applicant":"FENNEC PHARMACEUTICALS INC","territory":"US","tradeName":"PEDMARK","expiryDate":"2039-07-01"},{"type":"Compound","number":"9585912","applicant":"HOPE PHARMACEUTICALS","territory":"US","tradeName":"SODIUM THIOSULFATE","expiryDate":"2030-07-07"},{"type":"Formulation","number":"11510984","applicant":"FENNEC PHARMACEUTICALS INC","territory":"US","tradeName":"PEDMARK","expiryDate":"2039-07-01"},{"type":"Formulation","number":"12304813","applicant":"HOPE PHARMACEUTICALS","territory":"US","tradeName":"SODIUM THIOSULFATE","expiryDate":"2030-02-10"},{"type":"Formulation","number":"11291728","applicant":"FENNEC PHARMACEUTICALS INC","territory":"US","tradeName":"PEDMARK","expiryDate":"2039-07-01"}],"pricing":[],"_sources":{"trials":{"url":"https://clinicaltrials.gov/search?intr=SODIUM THIOSULFATE","method":"api_direct","source":"ClinicalTrials.gov","rawText":"","confidence":1,"sourceType":"ctgov","retrievedAt":"2026-04-20T03:17:22.604185+00:00"},"patents":{"url":"","method":"deterministic","source":"FDA Orange Book","rawText":"","confidence":1,"sourceType":"fda_orange_book","retrievedAt":"2026-04-20T03:17:19.676873+00:00"},"regulatory.ca":{"url":"","method":"api_direct","source":"Health Canada DPD","rawText":"","confidence":1,"sourceType":"health_canada_dpd","retrievedAt":"2026-04-20T03:17:29.137400+00:00"},"regulatory.eu":{"url":"","method":"api_direct","source":"European Medicines Agency","rawText":"","confidence":1,"sourceType":"ema_api","retrievedAt":"2026-04-20T03:17:22.626674+00:00"},"regulatory.us":{"url":"","method":"api_direct","source":"FDA Drugs@FDA","rawText":"","confidence":1,"sourceType":"fda_drugsfda","retrievedAt":"2026-04-20T03:17:18.285040+00:00"},"publicationCount":{"url":"https://pubmed.ncbi.nlm.nih.gov/?term=SODIUM THIOSULFATE","method":"api_direct","source":"PubMed/NCBI","rawText":"","confidence":1,"sourceType":"pubmed","retrievedAt":"2026-04-20T03:17:29.867975+00:00"},"administration.route":{"url":"","method":"deterministic","source":"FDA Label","rawText":"","confidence":1,"sourceType":"fda_label","retrievedAt":"2026-04-20T03:17:17.098318+00:00"},"safety.boxedWarnings":{"url":"","method":"deterministic","source":"FDA Label (no boxed warning)","rawText":"","confidence":1,"sourceType":"fda_label","retrievedAt":"2026-04-20T03:17:17.098358+00:00"},"safety.safetySignals":{"url":"https://api.fda.gov/drug/event.json","method":"api_direct","source":"FDA FAERS","rawText":"","confidence":1,"sourceType":"fda_faers","retrievedAt":"2026-04-20T03:17:32.355653+00:00"},"mechanism.oneSentence":{"url":"","method":"ai_extraction","source":"FDA Label + AI","aiModel":"featherless","rawText":"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","confidence":0.95,"sourceType":"fda_label","retrievedAt":"2026-04-20T03:17:49.604520+00:00"},"crossReferences.chemblId":{"url":"https://www.ebi.ac.uk/chembl/compound_report_card/CHEMBL2096650/","method":"api_direct","source":"ChEMBL (EMBL-EBI)","rawText":"","confidence":1,"sourceType":"chembl","retrievedAt":"2026-04-20T03:17:31.312507+00:00"},"safety.commonSideEffects":{"url":"","method":"ai_extraction","source":"FDA Label + AI","aiModel":"featherless","rawText":"6 ADVERSE REACTIONS There have been no controlled clinical trials conducted to systematically assess the adverse events profile of sodium thiosulfate. The medical literature has reported the following adverse events in association with sodium thiosulfate administration. These adverse events were not reported in the context of controlled trials or with consistent monitoring and reporting methodologies for adverse events. Therefore, frequency of occurrence of these adverse events cannot be assesse","confidence":0.95,"sourceType":"fda_label","retrievedAt":"2026-04-20T03:17:52.121926+00:00"},"regulatory.fda_application":{"url":"","method":"deterministic","source":"FDA Label","rawText":"NDA203923","confidence":1,"sourceType":"fda_label","retrievedAt":"2026-04-20T03:17:17.098364+00:00"}},"allNames":["sodium thiosulfate","disodium thiosulphate","sulfothiorine"],"offLabel":[],"synonyms":["sodium thiosulfate","disodium thiosulphate","sulfothiorine"],"timeline":[{"date":"1992-01-01","type":"neutral","source":"FDA Orange Book","milestone":"Rights transferred from US ARMY to Us Army"},{"date":"1992-02-14","type":"positive","source":"DrugCentral","milestone":"FDA approval (Us Army)"},{"date":"2012-02-14","type":"positive","source":"FDA Orange Book","milestone":"New formulation approved (Hope Pharms)"},{"date":"2022-09-20","type":"positive","source":"FDA Orange Book","milestone":"Pedmark approved — 12.5GM/100ML (125MG/ML)"},{"date":"2023-05-26","type":"positive","source":"DrugCentral","milestone":"EMA approval (Fennec Pharmaceuticals (EU) Limited)"}],"aiSummary":"Sodium thiosulfate is a small molecule drug originally developed by the US Army, which remains its current owner. It is FDA-approved for reducing the risk of ototoxicity associated with cisplatin and treating the toxic effects of cyanide. Despite being off-patent, there are no generic manufacturers. As a result, its commercial status is uncertain. Key safety considerations include its potential effects on kidney function and electrolyte balance.","approvals":[{"date":"1992-02-14","orphan":true,"company":"US ARMY","regulator":"FDA"},{"date":"2023-05-26","orphan":false,"company":"Fennec Pharmaceuticals (EU) Limited","regulator":"EMA"}],"brandName":"Sodium Thiosulfate","ecosystem":[{"indication":"Reduce the risk of ototoxicity associated with cisplatin","otherDrugs":[],"globalPrevalence":null},{"indication":"Toxic effect of cyanide","otherDrugs":[{"name":"amyl nitrite","slug":"amyl-nitrite","company":""},{"name":"cobalamin","slug":"cobalamin","company":""},{"name":"hydroxocobalamin","slug":"hydroxocobalamin","company":"Watson Labs"},{"name":"sodium nitrite","slug":"sodium-nitrite","company":"Hope Pharms"}],"globalPrevalence":null}],"mechanism":{"target":"cytochrome a3, rhodanese","modality":"Small Molecule","drugClass":"sodium thiosulfate","explanation":"Sodium nitrite reacts with hemoglobin to form methemoglobin, which binds cyanide, preventing it from inhibiting cytochrome a3 and restoring aerobic metabolism. Sodium thiosulfate enhances the body's natural process of converting cyanide to less toxic thiocyanate, which is then excreted.","oneSentence":"Sodium nitrite forms methemoglobin to bind cyanide, while sodium thiosulfate donates sulfur for cyanide conversion to thiocyanate.","technicalDetail":"Sodium nitrite reacts with hemoglobin to form methemoglobin, which has a high affinity for cyanide, forming cyanomethemoglobin and displacing cyanide from cytochrome a3. Sodium thiosulfate serves as a sulfur donor in the reaction catalyzed by rhodanese, converting cyanide to thiocyanate (SCN-)."},"commercial":{"launchDate":"1992","_launchSource":"DrugCentral (FDA 1992-02-14, US ARMY)"},"references":[{"id":1,"url":"https://drugcentral.org/drugcard/4518","fields":["approvals","synonyms","ATC","PK","indications","contraindications","DDIs","targets","patents","FAERS"],"source":"DrugCentral"},{"id":2,"url":"https://clinicaltrials.gov/search?intr=SODIUM%20THIOSULFATE","fields":["trials"],"source":"ClinicalTrials.gov"},{"id":3,"url":"https://pubmed.ncbi.nlm.nih.gov/?term=SODIUM THIOSULFATE","fields":["publications"],"source":"PubMed/NCBI"},{"id":4,"url":"https://www.fda.gov/drugs/drug-approvals-and-databases/orange-book-data-files","fields":["patents","exclusivity","genericManufacturers"],"source":"FDA Orange Book"}],"_emaChecked":true,"_enrichedAt":"2026-03-30T15:39:58.614577","_validation":{"fieldsValidated":2,"lastValidatedAt":"2026-04-20T03:17:58.036393+00:00","fieldsConflicting":0,"overallConfidence":0.95},"biosimilars":[],"competitors":[],"genericName":"sodium thiosulfate","indications":{"approved":[{"name":"Reduce the risk of ototoxicity associated with cisplatin","source":"DrugCentral","snomedId":292238004,"regulator":"FDA"},{"name":"Toxic effect of cyanide","source":"DrugCentral","snomedId":66207005,"regulator":"FDA"}],"offLabel":[],"pipeline":[]},"currentOwner":"Us Army","drugCategory":"active","labelChanges":[],"patentStatus":"Off-patent — no active Orange Book patents","relatedDrugs":[],"trialDetails":[{"nctId":"NCT04847063","phase":"PHASE1","title":"Individual Response to Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Treatment of Peritoneal Carcinomatosis From Peritoneal Mesothelioma or Atypical Mesothelial Proliferation or From Ovarian, Colorectal, or Appendiceal Histologies","status":"RECRUITING","sponsor":"National Cancer Institute (NCI)","startDate":"2021-10-19","conditions":["Peritoneal Mesothelioma","Peritoneal Carcinomatosis","Ovarian Cancer","Gastrointestinal Cancer","Appendiceal Cancer","Atypical Mesothelial Proliferation","Colorectal Cancer"],"enrollment":60,"completionDate":"2034-12-30"},{"nctId":"NCT03842982","phase":"PHASE3","title":"Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Ovarian Cancer (CHIPPI)","status":"ACTIVE_NOT_RECRUITING","sponsor":"Centre Oscar Lambret","startDate":"2019-05-03","conditions":["Ovary Neoplasms","Ovarian Cancer","Ovarian Carcinoma"],"enrollment":362,"completionDate":"2031-02-01"},{"nctId":"NCT05382338","phase":"PHASE3","title":"A Study of Treatment for Medulloblastoma Using Sodium Thiosulfate to Reduce Hearing Loss","status":"RECRUITING","sponsor":"Children's Oncology Group","startDate":"2023-02-20","conditions":["Childhood Medulloblastoma"],"enrollment":225,"completionDate":"2029-12-31"},{"nctId":"NCT07228429","phase":"","title":"Quantification of Calcinosis Cutis Disease Burden Using Computed Tomography Images","status":"RECRUITING","sponsor":"Yale University","startDate":"2025-10-14","conditions":["Systemic Sclerosis (SSc)","Calcinosis Cutis"],"enrollment":56,"completionDate":"2026-07"},{"nctId":"NCT07407582","phase":"PHASE1,PHASE2","title":"Ph. 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