Sodium thiosulfate (medical use)

Sodium thiosulfate, also spelled sodium thiosulphate, is used as a medication to treat cyanide poisoning, pityriasis versicolor, and to decrease side effects from cisplatin.[1][2] For cyanide poisoning it is often used after the medication sodium nitrite and typically only recommended for severe cases.[1][3] It is either given by injection into a vein or applied to the skin.[1]

Sodium thiosulfate
Sodium thiosulfate, structural formula
Clinical data
AHFS/Drugs.comMicromedex Detailed Consumer Information
Pregnancy
category
  • AU: N
Routes of
administration		Intravenous
ATC code
Legal status
Legal status
Identifiers
IUPAC name
  • Sodium thiosulfate
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
ChEBI
ChEMBL
Chemical and physical data
FormulaNa2O3S2
Molar mass158.10 g·mol−1
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

Side effects may include vomiting, joint pain, mood changes, psychosis, and ringing in the ears.[2] Safety, however, has not been well studied.[4] It is unclear if use in pregnancy is safe for the baby.[2] Use at the same time in the same intravenous line as hydroxocobalamin is not recommended.[3] In cyanide poisoning sodium nitrite creates methemoglobinemia which removes cyanide from mitochondria.[3] Sodium thiosulfate then binds with cyanide creating the nontoxic thiocyanate.[3]

Sodium thiosulfate came into medical use for cyanide poisoning in the 1930s.[5] It is on the World Health Organization's List of Essential Medicines.[6] The cost in the United States per dose as of 2013 is about US$20 while together with sodium nitrite it costs US$110.[7]

Medical uses

The main use of sodium thiosulfate is in cyanide poisoning and pityriasis versicolor.[1]

Cyanide poisoning

Sodium thiocyanate is a classical antidote to cyanide poisoning,[8] For this purpose it is used after the medication sodium nitrite and typically only recommended for severe cases.[1][3] It is given by injection into a vein.[1]

In this use, sodium nitrite creates methemoglobinemia which removes cyanide from mitochondria.[3] 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.[3][9]

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.[9]

In cases with both cyanide poisoning and carbon monoxide poisoning, sodium thiosulfate by itself is recommended.[10]

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.[11][12]

However, it has been claimed that this treatment may cause severe metabolic acidosis in some patients.[13][14]

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.[15]

The compound can also be used to measure the volume of extracellular body fluid and the renal glomerular filtration rate.[16]

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;[17][18] and for other fungal infections of the skin.[19]

Side effects

Side effects may include vomiting, joint pain, mood changes, psychosis, and ringing in the ears.[2] Safety; however, has not been well studied.[4] It is unclear if use in pregnancy is safe for the baby.[2] Use at the same time in the same intravenous line as hydroxocobalamin is not recommended.[3]

History

Sodium thiosulfate came into medical use for cyanide poisoning in the 1930s.[20]

References
  1. 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.
  2. "Sodium thiosulfate Intravenous Advanced Patient Information - Drugs.com". www.drugs.com. Archived from the original on 18 January 2017. Retrieved 15 January 2017.
  3. "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.
  4. "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.
  5. Dart, Richard C. (2004). Medical Toxicology. Lippincott Williams & Wilkins. p. 172. ISBN 9780781728454. Archived from the original on 2017-01-16.
  6. 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.
  7. 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.
  8. "Toxicity, Cyanide: Overview". eMedicine. Retrieved 2009-01-01.
  9. 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.
  10. Baren JM (2008). Pediatric Emergency Medicine. Elsevier Health Sciences. p. 1018. ISBN 978-1416000877.
  11. 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. S2CID 28366905.
  12. 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.
  13. Berns JS (24 April 2012). "Sodium Thiosulfate and Acidosis: A Puzzle for Readers". Medscape.
  14. 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. S2CID 23196149.
  15. 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.
  16. "Sodium thiosulfate" at Dorland's Medical Dictionary
  17. 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. S2CID 75657768.
  18. 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.
  19. 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. S2CID 46982698.
  20. Dart RC (2004). Medical Toxicology. Lippincott Williams & Wilkins. p. 172. ISBN 9780781728454.
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