Sodium thiosulfate (medical use)

Pharmaceutical compound

Sodium thiosulfate

Sodium thiosulfate, structural formula

Clinical data
Trade names| Pedmark, Pedmarqsi
AHFS/Drugs.com| Micromedex Detailed Consumer Information
Routes of
administration| Intravenous
ATC code|

* None

Legal status
Legal status|

* UK: POM (Prescription only)
* US: ℞-only[1]
* EU: Rx-only[2]

Identifiers

IUPAC name

* Sodium thiosulfate

CAS Number|

* 7772-98-7

PubChem CID|

* 24477

DrugBank|

* DBSALT002504

ChemSpider|

* 22885

UNII|

* L0IYT1O31N

ChEBI|

* CHEBI:132112

ChEMBL|

* ChEMBL3753202

Chemical and physical data
Formula| Na2O3S2
Molar mass| 158.10 g·mol−1
3D model (JSmol)|

* Interactive image

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

This article is about the use of sodium thiosulfate as a medication. For the chemical, see Sodium thiosulfate.

Sodium thiosulfate, also spelled sodium thiosulphate, is used as a medication to treat cyanide poisoning, pityriasis versicolor, and to decrease side effects from cisplatin.[3][4][5] For cyanide poisoning, it is often used after the medication sodium nitrite and is typically only recommended for severe cases.[4][6] It is either given by injection into a vein or applied to the skin.[4]

Side effects may include vomiting, joint pain, mood changes, psychosis, and ringing in the ears.[5] Safety, however, has not been well studied.[7] It is unclear if use during pregnancy is safe for the baby.[5] Its use at the same time in the same intravenous line as hydroxocobalamin is not recommended.[6] In cyanide poisoning, sodium nitrite creates methemoglobinemia, which removes cyanide from the mitochondria.[6] Sodium thiosulfate then binds with cyanide, creating the nontoxic thiocyanate.[6]

Sodium thiosulfate came into medical use for cyanide poisoning in the 1930s.[8] It is on the World Health Organization's List of Essential Medicines.[9]

## Medical uses

[edit]

The main use of sodium thiosulfate is in cyanide poisoning and pityriasis versicolor.[4]

### Cyanide poisoning

[edit]

Sodium thiosulfate is a classical antidote to cyanide poisoning,[10] For this purpose it is used after the medication sodium nitrite and typically only recommended for severe cases.[4][6] It is given by injection into a vein.[4]

In this use, sodium nitrite creates methemoglobinemia which removes cyanide from mitochondria.[6] 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.[6][11]

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.[11]

In cases with both cyanide poisoning and carbon monoxide poisoning, sodium thiosulfate by itself is recommended.[12]

### Reducing hearing loss during chemotherapy

[edit]

In September 2022, the U.S. Food and Drug Administration (FDA) approved sodium thiosulfate under the brand name Pedmark to lessen the risk of ototoxicity and hearing loss in infant, child, and adolescent cancer patients receiving the chemotherapy medication cisplatin.[3][13][14]

In the European Union, sodium thiosulfate (Pedmarqsi) is indicated for the prevention of ototoxicity induced by cisplatin chemotherapy in people aged 1 month to < 18 years of age with localized, non-metastatic, solid tumors.[2] The most common side effects include vomiting, nausea (feeling sick), hypernatremia (high blood levels of sodium), hypophosphatemia (low blood levels of phosphate) and hypokalemia (low blood levels of potassium).[2] Sodium thiosulfate (Pedmarqsi) was approved for medical use in the European Union in May 2023.[2]

### Hemodialysis

[edit]

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.[15][16]

However, it has been claimed that this treatment may cause severe metabolic acidosis in some patients.[17][18]

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.[19]

The compound can also be used to measure the volume of extracellular body fluid and the renal glomerular filtration rate.[20]

### Fungal infections of the skin

[edit]

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;[21][22] and for other fungal infections of the skin.[23]

## Side effects

[edit]

Side effects may include vomiting, joint pain, mood changes, psychosis, and ringing in the ears.[5] Safety; however, has not been well studied.[7] It is unclear if use in pregnancy is safe for the baby.[5] Use at the same time in the same intravenous line as hydroxocobalamin is not recommended.[6]

## History

[edit]

Sodium thiosulfate came into medical use for cyanide poisoning in the 1930s.[24]

## References

[edit]

1. ^ "Pedmark- sodium thiosulfate injection, solution". DailyMed. 30 September 2022. Archived from the original on 21 January 2023. Retrieved 21 January 2023.
2. ^ a b c d "Pedmarqsi EPAR". European Medicines Agency. 2 June 2023. Archived from the original on 3 June 2023. Retrieved 2 June 2023. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
3. ^ a b Orgel E, Villaluna D, Krailo MD, Esbenshade A, Sung L, Freyer DR (May 2022). "Sodium thiosulfate for prevention of cisplatin-induced hearing loss: updated survival from ACCL0431". The Lancet. Oncology. 23 (5): 570–572\. doi:10.1016/S1470-2045(22)00155-3. PMC 9635495. PMID 35489339.570-572&rft.date=2022-05&rft_id=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9635495#id-name=PMC&rft_id=info:pmid/35489339&rft_id=info:doi/10.1016/S1470-2045(22)00155-3&rft.aulast=Orgel&rft.aufirst=E&rft.au=Villaluna,+D&rft.au=Krailo,+MD&rft.au=Esbenshade,+A&rft.au=Sung,+L&rft.au=Freyer,+DR&rft_id=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9635495&rfr_id=info:sid/en.wikipedia.org:Sodium+thiosulfate+(medical+use)" class="Z3988">
4. ^ a b c d e f 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.
5. ^ a b c d e "Sodium thiosulfate Intravenous Advanced Patient Information - Drugs.com". www.drugs.com. Archived from the original on 18 January 2017. Retrieved 15 January 2017.
6. ^ a b c d e f g h "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.
7. ^ a b "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.
8. ^ Dart, Richard C. (2004). Medical Toxicology. Lippincott Williams & Wilkins. p. 172\. ISBN 9780781728454. Archived from the original on 2017-01-16.
9. ^ 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.
10. ^ "Toxicity, Cyanide: Overview". eMedicine. Archived from the original on 2008-12-29. Retrieved 2009-01-01.
11. ^ a b 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 17098327.806-13&rft.date=2007-06&rft_id=info:doi/10.1016/j.annemergmed.2006.09.021&rft_id=info:pmid/17098327&rft.aulast=Hall&rft.aufirst=AH&rft.au=Dart,+R&rft.au=Bogdan,+G&rfr_id=info:sid/en.wikipedia.org:Sodium+thiosulfate+(medical+use)" class="Z3988">
12. ^ Baren JM (2008). Pediatric Emergency Medicine. Elsevier Health Sciences. p. 1018\. ISBN 978-1416000877.
13. ^ Winstead, Edward (October 6, 2022). "Sodium Thiosulfate Reduces Hearing Loss in Kids with Cancer". National Cancer Institute. Archived from the original on March 9, 2023. Retrieved March 9, 2023.
14. ^ "FDA approves sodium thiosulfate to reduce the risk of ototoxicity associated with cisplatin in pediatric patients with localized, non-metastatic solid tumors". U.S. Food and Drug Administration. 20 September 2022. Archived from the original on 9 March 2023. Retrieved 9 March 2023.
15. ^ 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 28366905.339-46&rft.date=2011-10&rft_id=https://api.semanticscholar.org/CorpusID:28366905#id-name=S2CID&rft_id=info:pmid/21834598&rft_id=info:doi/10.2165/11587060-000000000-00000&rft.aulast=Auriemma&rft.aufirst=M&rft.au=Carbone,+A&rft.au=Di+Liberato,+L&rft.au=Cupaiolo,+A&rft.au=Caponio,+C&rft.au=De+Simone,+C&rft.au=Tulli,+A&rft.au=Bonomini,+M&rft.au=Amerio,+P&rfr_id=info:sid/en.wikipedia.org:Sodium+thiosulfate+(medical+use)" class="Z3988">
16. ^ 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 15168392.1104-8&rft.date=2004-06&rft_id=info:doi/10.1053/j.ajkd.2004.03.018&rft_id=info:pmid/15168392&rft.aulast=Cicone&rft.aufirst=JS&rft.au=Petronis,+JB&rft.au=Embert,+CD&rft.au=Spector,+DA&rfr_id=info:sid/en.wikipedia.org:Sodium+thiosulfate+(medical+use)" class="Z3988">
17. ^ Berns JS (24 April 2012). "Sodium Thiosulfate and Acidosis: A Puzzle for Readers". Medscape. Archived from the original on 21 September 2015. Retrieved 16 February 2019.
18. ^ 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 23196149.85-8&rft.date=2011-01/2011-02&rft_id=https://api.semanticscholar.org/CorpusID:23196149#id-name=S2CID&rft_id=info:pmid/21338397&rft_id=info:doi/10.1111/j.1525-139X.2011.00848.x&rft.aulast=Selk&rft.aufirst=N&rft.au=Rodby,+RA&rfr_id=info:sid/en.wikipedia.org:Sodium+thiosulfate+(medical+use)" class="Z3988">
19. ^ 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 17699422.258-63&rft.date=2007-03&rft_id=info:doi/10.2215/CJN.03250906&rft_id=info:pmid/17699422&rft.aulast=Yerram&rft.aufirst=P&rft.au=Saab,+G&rft.au=Karuparthi,+PR&rft.au=Hayden,+MR&rft.au=Khanna,+R&rft_id=https://doi.org/10.2215%2FCJN.03250906&rfr_id=info:sid/en.wikipedia.org:Sodium+thiosulfate+(medical+use)" class="Z3988">
20. ^ "Sodium thiosulfate" at Dorland's Medical Dictionary
21. ^ 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 75657768.648-55&rft.date=1998-09&rft_id=https://api.semanticscholar.org/CorpusID:75657768#id-name=S2CID&rft_id=info:pmid/9762812&rft_id=info:doi/10.1046/j.1365-4362.1998.00441.x&rft.aulast=Sunenshine&rft.aufirst=PJ&rft.au=Schwartz,+RA&rft.au=Janniger,+CK&rfr_id=info:sid/en.wikipedia.org:Sodium+thiosulfate+(medical+use)" class="Z3988">
22. ^ 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 20956647.1132-40&rft.date=2010-10&rft_id=info:doi/10.1001/archdermatol.2010.259&rft_id=info:pmid/20956647&rft.aulast=Hu&rft.aufirst=SW&rft.au=Bigby,+M&rfr_id=info:sid/en.wikipedia.org:Sodium+thiosulfate+(medical+use)" class="Z3988">
23. ^ 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 46982698.674-82&rft.date=1992-05&rft_id=https://api.semanticscholar.org/CorpusID:46982698#id-name=S2CID&rft_id=info:pmid/1379146&rft_id=info:doi/10.2165/00003495-199243050-00004&rft.aulast=Rezabek&rft.aufirst=GH&rft.au=Friedman,+AD&rfr_id=info:sid/en.wikipedia.org:Sodium+thiosulfate+(medical+use)" class="Z3988">
24. ^ Dart RC (2004). Medical Toxicology. Lippincott Williams & Wilkins. p. 172\. ISBN 9780781728454.

* v
* t
* e

Antidotes (V03AB)

Nervous
system|

| Alcohol intoxication|

* Metadoxine
* Thiamine

|

Barbiturate
overdose|

* Bemegride
* Ethamivan

Benzodiazepine
overdose|

* Cyprodenate
* Flumazenil

GHB overdose|

* Physostigmine
* SCH-50911

Nerve agent /
Organophosphate
poisoning|

* Atropine#
* Biperiden
* Diazepam#
* Oximes
* Obidoxime
* Pralidoxime
* see also: Cholinesterase

Opioid overdose|

* Diprenorphine
* Doxapram
* Nalmefene
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* Naltrexone

Reversal of
neuromuscular blockade|

* Sugammadex

Circulatory
system|

| Beta blocker|

* Glucagon

|

Digoxin toxicity|

* Digoxin immune fab

Anticoagulants|

* against direct Xa inhibitors (Andexanet alfa)
* against heparin (Protamine#)

Other|

| Arsenic poisoning|

* Dimercaprol#
* Succimer

|

Cyanide poisoning|

* 4-Dimethylaminophenol
* Hydroxocobalamin
* nitrite
* Amyl nitrite
* Sodium nitrite#
* Sodium thiosulfate#

Hydrofluoric acid|

* Calcium gluconate#

Methanol /
Ethylene glycol
poisoning|

* Primary alcohols: Ethanol
* Fomepizole

Paracetamol toxicity
(Acetaminophen)|

* Acetylcysteine#
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Toxic metals (cadmium

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* Dimercaprol#
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Other|

* iodine-131
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