Natriumthiosulfaat Hope (Sodium Thiosulfate)

Sodium Thiosulfate is used in clinical situations that require detoxification of cyanide or calcium chelation.

• Cyanide poisoning: rapidly converts cyanide to the less toxic thiocyanate for renal excretion.
• Calciphylaxis: chelates calcium deposits in small vessels, helping to reduce painful skin lesions.
• Radiation‑induced mucositis: mitigates mucosal injury and promotes healing in patients receiving radiotherapy.

• Sodium Thiosulfate acts as a sulfur donor for the mitochondrial enzyme rhodanese, facilitating the conversion of cyanide to thiocyanate, which is then eliminated by the kidneys. In calciphylaxis, it binds calcium ions, forming soluble complexes that reduce vascular calcification and improve tissue perfusion.

Sodium Thiosulfate may cause a range of adverse reactions, most of which are mild and transient.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Hypotension: transient drop in blood pressure during infusion.
• Headache: occasional mild headache during or after administration.

Serious or Rare Side Effects

• Anaphylaxis: severe allergic reaction requiring immediate medical attention.
• Metabolic acidosis: significant acid‑base disturbance, especially in renal impairment.
• Renal impairment: worsening kidney function in susceptible patients.
• Hemolysis: breakdown of red blood cells, observed rarely.
• Arrhythmia: irregular heart rhythm in high‑risk individuals.

When using Sodium Thiosulfate, clinicians should consider several safety measures.

• Renal function: evaluate baseline kidney function and monitor during therapy.
• Blood pressure: observe for hypotension, especially during rapid infusion.
• Pregnancy: use only if the potential benefit justifies the potential risk to the fetus.
• Concomitant cyanide sources: avoid exposure to additional cyanide‑generating agents.
• Calcium supplements: assess need, as they may diminish chelation efficacy.
• Store at ambient temperature: keep in the original container, protect from light and moisture.

Sodium Thiosulfate can interact with other medicines, requiring attention to avoid reduced efficacy or increased toxicity.

Major Interactions (Avoid)

• Nitroprusside: may increase cyanide production, worsening toxicity.
• High‑dose vitamin B12: can interfere with thiosulfate metabolism.
• Calcium supplements: may reduce the drug's calcium‑chelation effect.

Moderate Interactions (Monitor Closely)

• Loop diuretics: may alter electrolyte balance, necessitating monitoring.
• ACE inhibitors: can potentiate hypotensive effects during infusion.
• Anticoagulants: may increase bleeding risk, requiring careful observation.