Sodium Nitrite for Acute Cyanide Poisoning

Primary Therapeutic Classification

Sodium nitrite functions as a cyanide antidote through its ability to induce methemoglobin formation, which has high affinity for cyanide ions and helps sequester them from critical cellular targets, according to the American Heart Association 1, 2
The American Heart Association classifies sodium nitrite as a second-line cyanide antidote, recommended when hydroxocobalamin is unavailable 1, 2

Sodium nitrite is positioned as an alternative to hydroxocobalamin, particularly when carbon monoxide poisoning is not a concern, since methemoglobin formation can further impair oxygen-carrying capacity in patients with concurrent carbon monoxide exposure 1, 2
The drug is typically administered in combination with sodium thiosulfate, which enhances cyanide elimination by serving as a substrate for enzymatic conversion of cyanide to thiocyanate 1, 2

Precise dosing is critical in children and patients with anemia to avoid excessive methemoglobin formation—the prescribing information provides specific weight-based and hemoglobin-adjusted dosing requirements 1, 2