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
Trade namesVersiclear, others
AHFS/Drugs.comMicromedex Detailed Consumer Information
Pregnancy
category
  • US: C (Risk not ruled out)
    ATC code
    Identifiers
    CAS Number
    PubChem CID
    ChemSpider
    UNII
    ChEBI
    Chemical and physical data
    FormulaNa2S2O3
    Molar mass158.108
    3D model (JSmol)

    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 intravensous 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, the most effective and safe medicines needed in a health system.[6] The cost in the United States per dose as of 2013 is about 20 USD while together with sodium nitrite it costs 110 USD.[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 wiith renal 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 intravensous line as hydroxocobalamin is not recommended.[3]

    History

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

    References
    1. WHO Model Formulary 2008 (PDF). World Health Organization. 2009. pp. 66, 298. ISBN 9789241547659. Archived (PDF) from the original on 13 December 2016. Retrieved 8 January 2017.
    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. "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016.
    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. 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.
    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.
    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.
    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.
    20. Dart RC (2004). Medical Toxicology. Lippincott Williams & Wilkins. p. 172. ISBN 9780781728454.
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