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hydroxocobalamin
V03AB33
Forms & Strengths
- Lyophilized powder for injection: 5 g per vial
Adult Dosing
- Cyanide poisoning: Initial 5 g IV infusion over 15 minutes
- Repeat dose: 5 g IV up to a total of 10 g based on severity and clinical response
Pediatric Dosing
- Cyanide poisoning (Neonates to Adolescents): 70 mg/kg IV up to a maximum single dose of 5 g infused over 15 minutes
- Repeat dose: 70 mg/kg up to a total cumulative dose of 140 mg/kg
Indications
- Treatment of known or suspected cyanide poisoning
Mechanism of Action
- Binds to cyanide ions with the hydroxycobalamin cobalt moiety displacing the hydroxyl group to form cyanocobalamin
- Cyanocobalamin is subsequently excreted renally, effectively neutralizing cyanide toxicity and restoring cellular respiration
Contraindications
- Hypersensitivity to hydroxocobalamin or cyanocobalamin
Adverse Reactions
- Chromaturia (red-colored urine)
- Erythema (skin redness)
- Rash, urticaria, and allergic reactions including anaphylaxis
- Transient hypertension and increased heart rate
- Nausea, headache, and injection site reactions
- Interference with clinical laboratory assays due to dark red color
Drug Interactions
- Physical incompatibility in IV lines: do not mix with concurrent blood products, ascorbic acid, diazepam, dobutamine, dopamine, or fentanyl
- May interfere with the accuracy of various clinical laboratory tests including total bilirubin, creatinine, and magnesium due to intense coloration
Curated Content: Needs Vetting Before Put to Clinical Use