Medicine:Sodium thiosulfate (medical use)

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Sodium thiosulfate
Sodium thiosulfate.svg
Sodium thiosulfate, structural formula
Clinical data
Trade namesPedmark, Pedmarqsi
AHFS/Drugs.comMicromedex Detailed Consumer Information
Routes of
administration		Intravenous
ATC code
  • None
Legal status
Legal status
Identifiers
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
ChEBI
ChEMBL
Chemical and physical data
FormulaNa2O3S2
Molar mass158.10 g·mol−1
3D model (JSmol)

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

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

Cyanide poisoning

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

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

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

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

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

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

References

  1. ↑ "Pedmark- sodium thiosulfate injection, solution". 30 September 2022. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f98c7076-2a7b-4fd7-ab90-eed5e9137bae. 
  2. ↑ 2.0 2.1 2.2 2.3 "Pedmarqsi EPAR". 2 June 2023. https://www.ema.europa.eu/en/medicines/human/EPAR/pedmarqsi.  Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
  3. ↑ 3.0 3.1 "Sodium thiosulfate for prevention of cisplatin-induced hearing loss: updated survival from ACCL0431". The Lancet. Oncology 23 (5): 570–572. May 2022. doi:10.1016/S1470-2045(22)00155-3. PMID 35489339. 
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 WHO Model Formulary 2008. World Health Organization. 2009. pp. 66. ISBN 9789241547659. 
  5. ↑ 5.0 5.1 5.2 5.3 5.4 "Sodium thiosulfate Intravenous Advanced Patient Information - Drugs.com". https://www.drugs.com/cons/sodium-thiosulfate-intravenous.html. 
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 "Sodium Thiosulfate Solution for Injection - Summary of Product Characteristics (SPC) - (eMC)". https://www.medicines.org.uk/emc/medicine/32283. 
  7. ↑ 7.0 7.1 "Sodium Thiosulfate Injection - FDA prescribing information, side effects and uses". https://www.drugs.com/pro/sodium-thiosulfate-injection.html. 
  8. ↑ Dart, Richard C. (2004) (in en). Medical Toxicology. Lippincott Williams & Wilkins. p. 172. ISBN 9780781728454. https://books.google.com/books?id=BfdighlyGiwC&pg=PA172. 
  9. ↑ World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. 2019. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO. 
  10. ↑ "Toxicity, Cyanide: Overview". eMedicine. http://emedicine.medscape.com/article/814287-overview. 
  11. ↑ 11.0 11.1 "Sodium thiosulfate or hydroxocobalamin for the empiric treatment of cyanide poisoning?". Annals of Emergency Medicine 49 (6): 806–13. June 2007. doi:10.1016/j.annemergmed.2006.09.021. PMID 17098327. 
  12. ↑ Baren, Jill M. (2008). Pediatric Emergency Medicine. Elsevier Health Sciences. p. 1018. ISBN 978-1416000877. https://books.google.com/books?id=wpvux6RS-jsC&pg=PA1018. 
  13. ↑ Winstead, Edward (October 6, 2022). "Sodium Thiosulfate Reduces Hearing Loss in Kids with Cancer". https://www.cancer.gov/news-events/cancer-currents-blog/2022/fda-sodium-thiosulfate-cisplatin-hearing-loss-children. 
  14. ↑ "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. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-sodium-thiosulfate-reduce-risk-ototoxicity-associated-cisplatin-pediatric-patients. 
  15. ↑ "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. October 2011. doi:10.2165/11587060-000000000-00000. PMID 21834598. 
  16. ↑ "Successful treatment of calciphylaxis with intravenous sodium thiosulfate". American Journal of Kidney Diseases 43 (6): 1104–8. June 2004. doi:10.1053/j.ajkd.2004.03.018. PMID 15168392. 
  17. ↑ Berns, Jeffrey S. (24 April 2012). "Sodium Thiosulfate and Acidosis: A Puzzle for Readers". Medscape. http://www.medscape.com/viewarticle/762244. 
  18. ↑ "Unexpectedly severe metabolic acidosis associated with sodium thiosulfate therapy in a patient with calcific uremic arteriolopathy". Seminars in Dialysis 24 (1): 85–8. Jan–Feb 2011. doi:10.1111/j.1525-139X.2011.00848.x. PMID 21338397. 
  19. ↑ "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. March 2007. doi:10.2215/CJN.03250906. PMID 17699422. 
  20. ↑ "Sodium thiosulfate" at Dorland's Medical Dictionary
  21. ↑ "Tinea versicolor". International Journal of Dermatology 37 (9): 648–55. September 1998. doi:10.1046/j.1365-4362.1998.00441.x. PMID 9762812. 
  22. ↑ "Pityriasis versicolor: a systematic review of interventions". Archives of Dermatology 146 (10): 1132–40. October 2010. doi:10.1001/archdermatol.2010.259. PMID 20956647. 
  23. ↑ "Superficial fungal infections of the skin. Diagnosis and current treatment recommendations". Drugs 43 (5): 674–82. May 1992. doi:10.2165/00003495-199243050-00004. PMID 1379146. 
  24. ↑ Dart, Richard C. (2004). Medical Toxicology. Lippincott Williams & Wilkins. p. 172. ISBN 9780781728454. https://books.google.com/books?id=BfdighlyGiwC&pg=PA172. 



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