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Hydroxocobalamin

Classification

Vitamin (form of vitamin B12)

Indications

CCP: Known cyanide toxicity

CCP: Suspicion of cyanide toxicity based on presence of smoke inhalation (i.e. fire victim from enclosed space) or CN ingestion/exposure (i.e. industrial)

AND

CCP: Altered LOC (GCS ≤ 13), or profound shock (SBP ≤ 90) despite resuscitation, or Lactate ≥ 8 mmol/L

Contraindications

Hypersensitivity to hydroxocobalamin

Adult dosages

CCP: All indications

5g IV given over 15 minutes
Additional doses are generally not required. Look for other causes of symptoms. May repeat 2.5g IV dose if required based on clinical response (ie. Lactate Levels) and prolonged transport times
Reconstitute each 5g vial with 200 mL NS prior to administration
Administer through separate IV line, do not mix with other products

Pediatric Considerations And Dosing

Follow weight-based dosing

CCP: All indications

Pediatric Dosing
- 70 mg/kg (up to 5g) IV infusion over 15 minutes
- Additional doses are generally not required. Look for other causes of symptoms. May repeat second half dose (35 mg/kg - up to 2.5g) dose if required based on clinical response (i.e Lactate Levels) and prolonged transport times.
Reconstitute each 5g vial with 200 mL NS prior to administration.
Administer through separate IV line, do not mix with other products.

Mechanism Of Action

Hydroxocobalamin binds directly with cyanide molecules, preventing cyanide binding to cellular mitochondria.

Pharmacokinetics

Intravenous:

Onset: Immediate
Half-life: 24-48 hours

Adverse Effects

Hydroxocobalamin may cause a temporary reddish discoloration of the skin, plasma, urine, and mucous membranes; these changes last for approximately 2-3 days

Overdose

Single doses of hydroxocobalamin are safe in all patients without hypersensitivities to vitamin B12.

Warning And Precautions

Hydroxocobalamin may interfere with CO-oximetry measurements, complicating the assessment of victims of smoke inhalation who may suffer from both cyanide and carbon monoxide poisoning.