sodium thiosulfate

Action and Spectrum

Actions and Spectrum: 

sodium thiosulfate is a pharmaceutical agent that has several uses in medicine. Its immediate actions include its ability to neutralize certain toxins and as an antidote for cyanide poisoning. sodium thiosulfate has a broad spectrum of use and is used to treat the following conditions: 

• Cyanide poisoning: sodium thiosulfate is an antidote for cyanide poisoning. It works by binding to the cyanide ions and forming a less toxic compound that the body can excrete. 
• Calciphylaxis: sodium thiosulfate is used to treat calciphylaxis, a rare and severe condition in which calcium deposits form in the blood vessels, leading to tissue damage and necrosis. sodium thiosulfate works by chelating calcium ions and preventing their deposition in the blood vessels. 
• Dermatological conditions: sodium thiosulfate is used topically to treat various dermatological conditions such as acne, eczema, and psoriasis. It is thought to work by reducing inflammation and killing bacteria on the skin. 
• Heavy metal toxicity: sodium thiosulfate treats heavy metal toxicity, particularly lead poisoning. It works by binding to the heavy metal ions and forming a less toxic compound that the body can excrete. 
• Radiation-induced skin toxicity: sodium thiosulfate is used to treat skin toxicity caused by radiation therapy. It works by reducing the oxidative stress and inflammation caused by radiation. 

Drug Interaction

Adverse Reaction

Frequency Defined 

>10% 

Vomiting  

Nausea  

Hypokalemia 

Hypernatremia  

Decreased hemoglobin  

Hypokalemia  

Hypophosphatemia  

Pyrexia  

Hyponatremia 

Hypophosphatemia 

Decreased hemoglobin 

Stomatitis 

1-10% 

Nausea 

Hypermagnesemia 

Vomiting 

Frequency not defined 

Nausea/vomiting 

Prolonged bleeding therapy 

Hypersensitivity reactions 

Disorientation 

Headache 

Contact dermatitis 

Warmth 

Metabolic acidosis 

Local irritation 

Black Box Warning

Contraindication / Caution

Contraindication/Caution: 

sodium thiosulfate is generally considered safe when used as directed by a healthcare provider. However, specific contraindications and precautions should be considered before using sodium thiosulfate. These include: 

• Hypersensitivity: sodium thiosulfate should not be used in patients with known hypersensitivity or allergy to the medication. 
• sodium-restricted diets: sodium thiosulfate contains sodium and should be used cautiously in patients on a sodium-restricted diet. 
• Electrolyte imbalances: sodium thiosulfate can affect electrolyte levels in the body, particularly sodium, and potassium. It should be used with caution in patients with pre-existing electrolyte imbalances. 
• Renal impairment: sodium thiosulfate is excreted primarily by the kidneys and should be used cautiously in patients with renal impairment. Dose adjustment may be necessary. 
• Pregnancy and breastfeeding: The safety of sodium thiosulfate during pregnancy and breastfeeding is not well established. It should be used cautiously in pregnant or breastfeeding women and only if the potential benefits outweigh the risks. 
• Drug interactions: sodium thiosulfate may interact with other medications, particularly those that affect electrolyte levels or are excreted by the kidneys.

Pregnancy / Lactation

Pregnancy consideration:  

No data available for utilization in pregnant women 

Breastfeeding warnings:  

Drug distribution in breastmilk is unknown 

Pregnancy category: 

• Category A: Satisfactory and well-controlled studies show no risk to the fetus in the first or later trimester. 
• Category B: No evidence of risk to the fetus is found in animal reproduction studies, and there are not enough studies on pregnant women. 
• Category C: Adverse effects on the fetus found with evidence in animal reproduction studies and no adequate evidence for a human product; Pregnant women must take care of the potential risks. 
• Category D: There is adequate data with sufficient evidence of human fetal risk from various platforms. However, despite potential dangers may be used only in emergencies for potential benefits. 
• Category X: Drugs listed in this category outweigh the risks over benefits. The drug is not for pregnant women. 
• Category N: No data for the drug under this category is available. 

Pharmacology

Pharmacology: 

sodium thiosulfate is a pharmaceutical agent that has several pharmacological actions. It works by chelating heavy metals and neutralizing certain toxins. sodium thiosulfate is a source of thiosulfate ions, which can react with heavy metal ions and form complexes that are less toxic and more easily excreted by the body. The thiosulfate ions also act as a reducing agent, which is why it is used to treat conditions like cyanide poisoning. 

In addition to its chelating and detoxifying actions, sodium thiosulfate has other pharmacological effects. It is known to reduce inflammation and oxidative stress, which makes it helpful in treating conditions like radiation-induced skin toxicity. sodium thiosulfate can also reduce the formation of calcium deposits in the blood vessels, making it helpful in treating calciphylaxis. 

sodium thiosulfate is administered intravenously or topically, depending on the treated condition. After administration, it is rapidly metabolized and excreted by the kidneys, with a half-life of about 12 hours. 

Pharmacodynamics: 

The pharmacodynamics of sodium thiosulfate are primarily related to its ability to chelate heavy metals, neutralize certain toxins, and reduce inflammation and oxidative stress. These effects are mediated by the thiosulfate ions present in the medication. 

When sodium thiosulfate is administered, the thiosulfate ions in the medication readily react with heavy metal ions in the body, forming less toxic complexes and more easily excreted. This chelating action is particularly useful in treating heavy metal toxicity, such as mercury or lead poisoning. 

sodium thiosulfate also can neutralize certain toxins, such as cyanide. In the body, thiosulfate ions react with cyanide ions to form thiocyanate, which is less toxic and more easily excreted. 

In addition to its chelating and detoxifying actions, sodium thiosulfate has been shown to have anti-inflammatory and antioxidant effects. It can reduce the production of pro-inflammatory cytokines and reactive oxygen species, contributing to oxidative stress and inflammation. 

The pharmacodynamics of sodium thiosulfate also include its ability to prevent the formation of calcium deposits in the blood vessels, which helps treat calciphylaxis. 

Pharmacokinetics 

The pharmacokinetics of sodium thiosulfate involve its absorption, distribution, metabolism, and elimination from the body. 

Absorption 

sodium thiosulfate is usually administered intravenously 

Distribution 

After injection, it rapidly distributes into the extracellular fluid.  

The volume of distribution of sodium thiosulfate is significant, indicating that it distributes widely throughout the body. 

Metabolism 

It is not metabolized in the body and is excreted unchanged primarily in the urine. 

Elimination and Excretion 

The elimination half-life of sodium thiosulfate is approximately 12 hours. 

The kidneys primarily eliminate sodium thiosulfate, and its clearance is proportional to the glomerular filtration rate.

Adminstartion

Administration: 

Several routes can administer sodium thiosulfate, including intravenous injection, topical application, and oral ingestion. The route of administration will depend on the medical condition being treated.  

Intravenous administration is the most common route of administration for sodium thiosulfate. It is typically given slowly over several minutes as a bolus injection or infusion. The dosage and duration of treatment depends on the specific condition and the patient’s factors, such as age, weight, and renal function.  

Topical administration of sodium thiosulfate is used primarily to treat skin conditions, such as calciphylaxis or radiation-induced skin toxicity. The medication is usually applied directly to the affected area as a cream or gel.  

Oral administration of sodium thiosulfate is less common, but it may be used in some cases to treat certain types of poisoning, such as cyanide toxicity. In these cases, the medication is usually given as a solution or tablet to be swallowed. 

Patient Information Leaflet

Patient information leaflet 

Generic Name:  sodium thiosulfate 

Pronounced: SOW-dee-um-thye-oh-SUL-fate 

Why do we use sodium thiosulfate? 

sodium thiosulfate is used for several medical purposes due to its ability to chelate heavy metals, neutralize certain toxins, and reduce inflammation and oxidative stress. Some of the common uses of sodium thiosulfate are: 

• Treatment of cyanide poisoning: sodium thiosulfate can react with cyanide to form a less toxic compound easily excreted from the body, making it helpful in treating cyanide poisoning. 
• Treatment of heavy metal poisoning: sodium thiosulfate can chelate heavy metals, such as lead, mercury, and arsenic, making it helpful in treating heavy metal poisoning. 
• Treatment of calciphylaxis: sodium thiosulfate can prevent the formation of calcium deposits in the blood vessels, which helps treat calciphylaxis. 
• Treatment of radiation-induced skin toxicity: sodium thiosulfate has been shown to reduce the severity of skin toxicity caused by radiation therapy. 
• Treatment of certain skin conditions: sodium thiosulfate can be used topically to treat certain skin conditions, such as calciphylaxis, radiation-induced skin toxicity, and some fungal infections.