Sodium thiosulfate 

Category:

• Miscellaneous

Description:

• Antidote, toxicology agent

Indications:

• Acne vulgaris

• Cyanide toxicity

• Tinea versicolor

Contraindications:

• Discontinue if irritation occurs while using topical formulation

• Use in or around eyes

Precautions:

• Pregnancy category C

Adverse Reactions (Side Effects):

• diarrhea

Dosage:

Administered intravenously, topically (no commercial topical agents available)

Cyanide toxicity: 

• Adult: 

  • Following administration of sodium nitrite (IV 300mg over 3-5 minutes), the usual dose of sodium thiosulfate is 12.5g (50ml of a 25% solution or 25ml of a 50% solution) over 10 minutes

• Child: 

  • Following administration of sodium nitrite (0.15-0.33 ml/kg or 6-8 ml/square meter of a 3% solution; approximately 4.5-10 mg/kg), the suggested dose of sodium thiosulfate is 1.65 ml/kg or 28 ml/square meter of a 25% solution (412.5 mg/kg); 

  • alternatively, dosing can be based on the child’s hemoglobin (hg) concentration:

    • If hg concentration is 8g, initial dose IV 1.10 ml/kg as a 25% solution

    • If hg concentration is 10g, initial dose IV 1.35 ml/kg as a 25% solution

    • If hg concentration is 12g, initial dose IV 1.65 ml/kg as a 25% solution

    • If hg concentration is 14g, initial dose IV 1.95 ml/kg as a 25% solution

• NOTE: If symptoms of cyanide toxicity recur, one half of each dose of sodium nitrite and sodium thiosulfate may be repeated after 30 minutes

Treatment of acne secondary to oily skin: 

• Adults: 

  • Apply thin layer of sodium thiosulfate lotion twice daily after thoroughly washing affected area

Treatment of tinea versicolor: 

• Adult and child: 

  • Apply a 20%-25% solution in a thin layer to affected areas twice daily.  

• May take weeks or months of continued therapy after condition clears to prevent relapse