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Sodium Nitrite/Sodium Thiosulfate

Life Threatening Hypotension and Methemoglobin Formation

  • Sodium nitrite can cause serious adverse reactions and death in humans, even at doses less than twice the recommended therapeutic dose.
  • Sodium nitrite causes hypotension and methemoglobin formation, which diminishes oxygen carrying capacity. Hypotension and methemoglobin formation can occur concurrently or separately.
  • ¬†Because of these risks, sodium nitrite should be used to treat acute life-threatening cyanide poisoning and be used with caution in patients where the diagnosis of cyanide poisoning is uncertain.
  • Patients should be closely monitored to ensure adequate perfusion and oxygenation during treatment with sodium nitrite.
  • Alternative therapeutic approaches should be considered in patients known to have diminished oxygen or cardiovascular reserve (e.g. smoke inhalation victims, pre-existing anemia, cardiac or respiratory compromise), and those at higher risk of developing methemoglobinemia (e.g., congenital methemoglobin reductase deficiency) as they are at greater risk for potentially life-threatening adverse events related to the use of sodium nitrite.


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Updated January 2018