Sodium thiosulfate (medical use)

Sodium thiosulfate
Sodium thiosulfate, structural formula
Names
Trade namesVersiclear, others
IUPAC name
  • Sodium thiosulfate
Clinical data
Pregnancy
category
  • US: C (Risk not ruled out)
    Defined daily dosenot established[1]
    External links
    AHFS/Drugs.comMicromedex Detailed Consumer Information
    US NLMSodium thiosulfate (medical use)
    Chemical and physical data
    FormulaNa2S2O3
    Molar mass158.108
    3D model (JSmol)
    SMILES
    • [O-]S(=O)(=S)[O-].[Na+].[Na+]
    InChI
    • InChI=1S/2Na.H2O3S2/c;;1-5(2,3)4/h;;(H2,1,2,3,4)/q2*+1;/p-2
    • Key:AKHNMLFCWUSKQB-UHFFFAOYSA-L

    Sodium thiosulfate, also spelled sodium thiosulphate, is used as a medication to treat cyanide poisoning, pityriasis versicolor, and to decrease side effects from cisplatin.[2][3] For cyanide poisoning it is often used after the medication sodium nitrite and typically only recommended for severe cases.[2][4] It is either given by injection into a vein or applied to the skin.[2]

    Side effects may include vomiting, joint pain, mood changes, psychosis, and ringing in the ears.[3] Safety, however, has not been well studied.[5] It is unclear if use in pregnancy is safe for the baby.[3] Use at the same time in the same intravenous line as hydroxocobalamin is not recommended.[4] In cyanide poisoning sodium nitrite creates methemoglobinemia which removes cyanide from mitochondria.[4] Sodium thiosulfate then binds with cyanide creating the nontoxic thiocyanate.[4]

    Sodium thiosulfate came into medical use for cyanide poisoning in the 1930s.[6] It is on the World Health Organization's List of Essential Medicines.[7] The cost in the United States per dose as of 2013 is about US$20 while together with sodium nitrite it costs US$110.[8]

    Medical uses

    The main use of sodium thiosulfate is in cyanide poisoning and pityriasis versicolor.[2]

    Cyanide poisoning

    Sodium thiocyanate is a classical antidote to cyanide poisoning,[9] For this purpose it is used after the medication sodium nitrite and typically only recommended for severe cases.[2][4] It is given by injection into a vein.[2]

    In this use, sodium nitrite creates methemoglobinemia which removes cyanide from mitochondria.[4] Sodium thiosulfate then serves as a sulfur donor for the conversion of cyanide to the nontoxic thiocyanate, catalyzed by the enzyme rhodanase. The thiocyanate is then safely excreted in the urine.[4][10]

    There are concerns that sodium thiosulfate may not have a fast enough onset of action to be very useful for this use without the additional use of other agents.[10]

    In cases with both cyanide poisoning and carbon monoxide poisoning, sodium thiosulfate by itself is recommended.[11]

    Hemodialysis

    There is a small amount of evidence supporting the use of sodium thiosulfate to counteract calciphylaxis, the calcification of blood vessels that may occur in hemodialysis patients with end-stage kidney disease.[12][13]

    However, it has been claimed that this treatment may cause severe metabolic acidosis in some patients.[14][15]

    Sodium thiosulfate has been observed to help in the treatment of a rare systemic fibrosis condition caused by gadolinium-based contrast media in patients with kidney failure.[16]

    The compound can also be used to measure the volume of extracellular body fluid and the renal glomerular filtration rate.[17]

    Fungal infections of the skin

    Foot baths of sodium thiosulfate are used for prophylaxis of ringworm. It is also used as a topical antifungal agent for tinea versicolor (pityriasis versicolor), possibly in combination with salicylic acid;[18][19] and for other fungal infections of the skin.[20]

    Dosage

    The defined daily dose is not established[1]

    Side effects

    Side effects may include vomiting, joint pain, mood changes, psychosis, and ringing in the ears.[3] Safety; however, has not been well studied.[5] It is unclear if use in pregnancy is safe for the baby.[3] Use at the same time in the same intravensous line as hydroxocobalamin is not recommended.[4]

    History

    Sodium thiosulfate came into medical use for cyanide poisoning in the 1930s.[21]

    References

    1. 1 2 "WHOCC - ATC/DDD Index". www.whocc.no. Archived from the original on 1 July 2021. Retrieved 13 September 2020.
    2. 1 2 3 4 5 6 World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 66. hdl:10665/44053. ISBN 9789241547659.
    3. 1 2 3 4 5 "Sodium thiosulfate Intravenous Advanced Patient Information - Drugs.com". www.drugs.com. Archived from the original on 18 January 2017. Retrieved 15 January 2017.
    4. 1 2 3 4 5 6 7 8 "Sodium Thiosulfate Solution for Injection - Summary of Product Characteristics (SPC) - (eMC)". www.medicines.org.uk. Archived from the original on 16 January 2017. Retrieved 15 January 2017.
    5. 1 2 "Sodium Thiosulfate Injection - FDA prescribing information, side effects and uses". www.drugs.com. Archived from the original on 18 January 2017. Retrieved 15 January 2017.
    6. ↑ Dart, Richard C. (2004). Medical Toxicology. Lippincott Williams & Wilkins. p. 172. ISBN 9780781728454. Archived from the original on 2017-01-16.
    7. ↑ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
    8. ↑ Gasco, L; Rosbolt, MB; Bebarta, VS (April 2013). "Insufficient stocking of cyanide antidotes in US hospitals that provide emergency care". Journal of Pharmacology & Pharmacotherapeutics. 4 (2): 95–102. doi:10.4103/0976-500x.110875. PMC 3669589. PMID 23761707.
    9. ↑ "Toxicity, Cyanide: Overview". eMedicine. Archived from the original on 2008-12-29. Retrieved 2009-01-01.
    10. 1 2 Hall AH, Dart R, Bogdan G (June 2007). "Sodium thiosulfate or hydroxocobalamin for the empiric treatment of cyanide poisoning?". Annals of Emergency Medicine. 49 (6): 806–13. doi:10.1016/j.annemergmed.2006.09.021. PMID 17098327.
    11. ↑ Baren, Jill M. (2008). Pediatric Emergency Medicine. Elsevier Health Sciences. p. 1018. ISBN 978-1416000877. Archived from the original on 2017-01-16. Retrieved 2017-01-15.
    12. ↑ Auriemma M, Carbone A, Di Liberato L, Cupaiolo A, Caponio C, De Simone C, Tulli A, Bonomini M, Amerio P (October 2011). "Treatment of cutaneous calciphylaxis with sodium thiosulfate: two case reports and a review of the literature". American Journal of Clinical Dermatology. 12 (5): 339–46. doi:10.2165/11587060-000000000-00000. PMID 21834598.
    13. ↑ Cicone JS, Petronis JB, Embert CD, Spector DA (June 2004). "Successful treatment of calciphylaxis with intravenous sodium thiosulfate". American Journal of Kidney Diseases. 43 (6): 1104–8. doi:10.1053/j.ajkd.2004.03.018. PMID 15168392.
    14. ↑ Berns, Jeffrey S. (24 April 2012). "Sodium Thiosulfate and Acidosis: A Puzzle for Readers". Medscape. Archived from the original on 21 September 2015. Retrieved 16 February 2019.
    15. ↑ Selk N, Rodby RA (Jan–Feb 2011). "Unexpectedly severe metabolic acidosis associated with sodium thiosulfate therapy in a patient with calcific uremic arteriolopathy". Seminars in Dialysis. 24 (1): 85–8. doi:10.1111/j.1525-139X.2011.00848.x. PMID 21338397.
    16. ↑ Yerram P, Saab G, Karuparthi PR, Hayden MR, Khanna R (March 2007). "Nephrogenic systemic fibrosis: a mysterious disease in patients with renal failure--role of gadolinium-based contrast media in causation and the beneficial effect of intravenous sodium thiosulfate". Clinical Journal of the American Society of Nephrology. 2 (2): 258–63. doi:10.2215/CJN.03250906. PMID 17699422.
    17. ↑ "Sodium thiosulfate" at Dorland's Medical Dictionary
    18. ↑ Sunenshine PJ, Schwartz RA, Janniger CK (September 1998). "Tinea versicolor". International Journal of Dermatology. 37 (9): 648–55. doi:10.1046/j.1365-4362.1998.00441.x. PMID 9762812.
    19. ↑ Hu SW, Bigby M (October 2010). "Pityriasis versicolor: a systematic review of interventions". Archives of Dermatology. 146 (10): 1132–40. doi:10.1001/archdermatol.2010.259. PMID 20956647.
    20. ↑ Rezabek GH, Friedman AD (May 1992). "Superficial fungal infections of the skin. Diagnosis and current treatment recommendations". Drugs. 43 (5): 674–82. doi:10.2165/00003495-199243050-00004. PMID 1379146.
    21. ↑ Dart, Richard C. (2004). Medical Toxicology. Lippincott Williams & Wilkins. p. 172. ISBN 9780781728454. Archived from the original on 2017-01-16. Retrieved 2017-01-15.
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