Sodium thiosulfate

Overview

Sodium thiosulfate, also spelled sodium thiosulphate, is used as a medication to treat cyanide poisoning, pityriasis versicolor, and to decrease side effects from cisplatin. For cyanide poisoning, it is often used after the medication sodium nitrite and is typically only recommended for severe cases. It is either given by injection into a vein or applied to the skin.[1–4] WP

Side effects may include vomiting, joint pain, mood changes, psychosis, and ringing in the ears. Safety, however, has not been well studied. It is unclear if use during pregnancy is safe for the baby. Its use at the same time in the same intravenous line as hydroxocobalamin is not recommended. In cyanide poisoning, sodium nitrite creates methemoglobinemia, which removes cyanide from the mitochondria. Sodium thiosulfate then binds with cyanide, creating the nontoxic thiocyanate.[3][4][5] WP

Sodium thiosulfate came into medical use for cyanide poisoning in the 1930s. It is on the World Health Organization's List of Essential Medicines.[6][7] WP

Uses, dosage and effects

Medical uses

The main use of sodium thiosulfate is in cyanide poisoning and pityriasis versicolor.[2] WP

Cyanide poisoning

Sodium thiosulfate is a classical antidote to cyanide poisoning, For this purpose it is used after the medication sodium nitrite and typically only recommended for severe cases. It is given by injection into a vein.[2][4][8] WP

In this use, sodium nitrite creates methemoglobinemia which removes cyanide from mitochondria. 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.[4][9] WP

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.[9] WP

In cases with both cyanide poisoning and carbon monoxide poisoning, sodium thiosulfate by itself is recommended.[10] WP

Reducing hearing loss during chemotherapy

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.[1][11][12] WP

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. 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). Sodium thiosulfate (Pedmarqsi) was approved for medical use in the European Union in May 2023.[13] WP

Hemodialysis

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.[14][15] WP

However, it has been claimed that this treatment may cause severe metabolic acidosis in some patients.[16][17] WP

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.[18] WP

The compound can also be used to measure the volume of extracellular body fluid and the renal glomerular filtration rate.[19] WP

Fungal infections of the skin

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; and for other fungal infections of the skin.[20][21][22] WP

Risks and side effects

Side effects

Side effects may include vomiting, joint pain, mood changes, psychosis, and ringing in the ears. Safety; however, has not been well studied. It is unclear if use in pregnancy is safe for the baby. Use at the same time in the same intravenous line as hydroxocobalamin is not recommended.[3][4][5] WP

History

History

Sodium thiosulfate came into medical use for cyanide poisoning in the 1930s.[6] WP

Chemistry

Formula

Na2O3S2 PC

CAS number

7772-98-7 PC

Molar mass (g/mol)

158.11 PC

IUPAC name (computed by PubChem)

disodium;dioxido-oxo-sulfanylidene-lambda6-sulfane PC

SMILES

[O-]S(=O)(=S)[O-].[Na+].[Na+] PC

InChIKey

AKHNMLFCWUSKQB-UHFFFAOYSA-L PC

PubChem CID

24477

Harm reduction information

No harm reduction data is on file for this compound yet. That means no dose, timing or combination data from PsychonautWiki or TripSit. Please don't guess a dose from similar compounds. If you have taken it and feel unwell, contact emergency services or a poison control center.

User reports

Pop culture

No references added yet.

Sources

1. Journal / agency Orgel E, Villaluna D, Krailo MD, Esbenshade A, Sung L, Freyer DR. Sodium thiosulfate for prevention of cisplatin-induced hearing loss: updated survival from ACCL0431. The Lancet. Oncology. May 2022. doi:10.1016/S1470-2045(22)00155-3 · PMID 35489339 · PMC9635495
2. Other World Health Organization. WHO Model Formulary 2008. 2009
3. Other Sodium thiosulfate Intravenous Advanced Patient Information - Drugs.com
4. Other Sodium Thiosulfate Solution for Injection - Summary of Product Characteristics (SPC) - (eMC)
5. Other Sodium Thiosulfate Injection - FDA prescribing information, side effects and uses
6. Other Dart, Richard C. Medical Toxicology. 2004
7. Other World Health Organization. World Health Organization model list of essential medicines: 21st list 2019. 2019
8. Other Toxicity, Cyanide: Overview
9. Journal / agency Hall AH, Dart R, Bogdan G. Sodium thiosulfate or hydroxocobalamin for the empiric treatment of cyanide poisoning?. Annals of Emergency Medicine. June 2007. doi:10.1016/j.annemergmed.2006.09.021 · PMID 17098327
10. Other Baren, Jill M. Pediatric Emergency Medicine. 2008
11. Other Winstead, Edward. Sodium Thiosulfate Reduces Hearing Loss in Kids with Cancer. October 6, 2022
12. Journal / agency FDA approves sodium thiosulfate to reduce the risk of ototoxicity associated with cisplatin in pediatric patients with localized, non-metastatic solid tumors. 20 September 2022
13. Journal / agency Pedmarqsi EPAR. 2 June 2023
14. Journal / agency Auriemma M, Carbone A, Di Liberato L, Cupaiolo A, Caponio C, De Simone C, Tulli A, Bonomini M, Amerio P. Treatment of cutaneous calciphylaxis with sodium thiosulfate: two case reports and a review of the literature. American Journal of Clinical Dermatology. October 2011. doi:10.2165/11587060-000000000-00000 · PMID 21834598
15. Journal / agency Cicone JS, Petronis JB, Embert CD, Spector DA. Successful treatment of calciphylaxis with intravenous sodium thiosulfate. American Journal of Kidney Diseases. June 2004. doi:10.1053/j.ajkd.2004.03.018 · PMID 15168392
16. Other Berns, Jeffrey S. Sodium Thiosulfate and Acidosis: A Puzzle for Readers. 24 April 2012
17. Journal / agency Selk N, Rodby RA. Unexpectedly severe metabolic acidosis associated with sodium thiosulfate therapy in a patient with calcific uremic arteriolopathy. Seminars in Dialysis. Jan–Feb 2011. doi:10.1111/j.1525-139X.2011.00848.x · PMID 21338397
18. Journal / agency Yerram P, Saab G, Karuparthi PR, Hayden MR, Khanna R. 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. March 2007. doi:10.2215/CJN.03250906 · PMID 17699422
19. Other DorlandsDict seven/000098060 Sodium thiosulfate
20. Journal / agency Sunenshine PJ, Schwartz RA, Janniger CK. Tinea versicolor. International Journal of Dermatology. September 1998. doi:10.1046/j.1365-4362.1998.00441.x · PMID 9762812
21. Journal / agency Hu SW, Bigby M. Pityriasis versicolor: a systematic review of interventions. Archives of Dermatology. October 2010. doi:10.1001/archdermatol.2010.259 · PMID 20956647
22. Journal / agency Rezabek GH, Friedman AD. Superficial fungal infections of the skin. Diagnosis and current treatment recommendations. Drugs. May 1992. doi:10.2165/00003495-199243050-00004 · PMID 1379146

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