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Hydroxocobalamin

Intravenous
Intramuscular
Class
Vitamin B12 analogs
Subclass
Cobalamins
Generic name
Hydroxocobalamin, hydroxycobalamin
Brand names
Cyanokit®
Dosage and administration
Adults patients
Treatment of cyanide poisoning
•
Loading: 5 g IV × 1 over 15 minutes
•
Subsequently: 5 g IV × 1 over 15-120 minutes if necessary
Indications for use
Labeled indications
Adults
•
Treatment of cyanide poisoning
Safety risks
Contraindications
Hypersensitivity to hydroxocobalamin or its components
Warnings and precautions
Hypertension
•
Maintain a high level of suspicion, as hydroxocobalamin may increase BP. Monitor BP during treatment.
Interference with cyanide assay
•
Maintain a high level of suspicion, as hydroxocobalamin may interfere with cyanide assay. Collect a pretreatment blood sample, although blood cyanide concentration is not required for the management of cyanide poisoning and should not delay treatment with hydroxocobalamin.
Interference with hemodialysis
•
Maintain a high level of suspicion, as hydroxocobalamin may cause hemodialysis machines to shut down due to erroneous blood leak detection caused by its deep red color.
Interference with laboratory tests
•
Maintain a high level of suspicion, as hydroxocobalamin interferes with the colorimetric determination of certain laboratory parameters, including clinical chemistry, hematology, coagulation, and urine parameters, due to its deep red color.
Photosensitivity of skin
•
Maintain a high level of suspicion, as hydroxocobalamin has the potential to cause photosensitivity reactions. Advise patients to avoid direct sun while their skin is discolored.
Renal dysfunction
•
Maintain a high level of suspicion, as hydroxocobalamin has been associated with an increased risk of acute renal failure with acute tubular necrosis, renal impairment, and urine calcium oxalate crystals. Monitoring renal function for 7 days following hydroxocobalamin therapy.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
No guidance available.
Renal replacement therapy
Any modality
•
No guidance available. Hydroxocobalamin may cause hemodialysis machines to shut down due to erroneous blood leak detection caused by its deep red color.
Hepatic impairment
Any severity
•
No guidance available.
Pregnancy and breastfeeding
Pregnancy
All trimesters
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals. Do not withhold life-sustaining therapy for cyanide poisoning due to pregnancy.
Breastfeeding
Halt breastfeeding temporarily.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Chromaturia, red urine, ↓ blood lymphocyte count, hypertension, ⊕ urine calcium oxalate crystals, headache, injection site reactions, skin rash, skin erythema
Common 1-10%
•
Nausea
Unknown frequency
•
Allergic reactions, ventricular premature beats, acute tubular necrosis, renal failure, red eyes, eye irritation, eyelid swelling, dysphagia, abdominal discomfort, vomiting, diarrhea, dyspepsia, hematochezia, peripheral edema, chest discomfort, memory impairment, dizziness, restlessness, dyspnea, throat dryness, throat tightness, urticaria, itching, hot flashes, tachycardia, pleural effusion, renal dysfunction
Interactions
Drug(s)
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