10-15-2024
The Ontario Poison Centre (OPC) has been made aware of a shortage of CYANOKIT® (hydroxocobalamin)
The Poison Centre recommends that hospitals keep expired stock to be used if necessary.
In the case of insufficient availability of hydroxocobalamin, alternative antidotes for cyanide poisoning may stocked and used when needed:
- Sodium nitrite (relatively contraindicated in fire exposed patients)
AND
See OPC Guideline for Stocking Emergency Antidotes for minimum stocking recommendations.
Urgent borrowing of antidotes from surrounding hospitals may be necessary. Prior arrangements to do this should be considered.
Consult the Poison Centre via the Priority Queue for cases of known or suspected cyanide poisoning: 416-813-5900 or 1-800-268-9017 (Toll-free); press “1” for Priority Queue.
The following recommendations may be considered by local and regional health care centres to conserve stock of hydroxocobalamin:
- Consider limiting prehospital use of hydroxocobalamin until laboratory confirmation of possible cyanide exposure is available (i.e. blood gas showing arterialization of venous blood gas with high lactate). Consult OPC for guidance on indications for antidote use.
- Consider alternate treatments for refractory vasoplegic shock in the critical care setting, including methylene blue.
Constance Mackenzie, MD, MSc
Assistant Medical Director
Ontario Poison Centre