Hydroxocobalamin
Classification
Vitamin (form of vitamin B12)
Indications
CCP: Patients with known cyanide ingestion
CCP: Patients from enclosed space fires with altered levels of consciousness
Contraindications
Allergy to hydroxocobalamin
Adult dosages
CCP: All indications
- 70 mg/kg IV. Typical adult dose is 5 g for a 71 kg person.
- Second half-dose may be given depending on the severity of the poisoning, or the clinical response to treatment
Pediatric Considerations And Dosing
CCP: All indications
- 70 mg/kg IV.
- Second half-dose may be given depending on the severity of the poisoning, or the clinical response to treatment
Mechanism Of Action
Hydroxocobalamin binds directly with cyanide molecules, which prevents cyanide binding to cellular mitochondria
Pharmocokinetics
Following IV administration:
- Onset: Immediate
- Half-life: 24-48 hours
Excretion is in the urine
Adverse Effects
Hydroxocobalamin may cause a temporary reddish discoloration of the skin, plasma, urine, and mucous membranes. These changes last for approximately two to three days.
Overdose
Single doses of hydroxocobalamin are safe in all patients not allergic 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.