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Clinical Practice Guidelines
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Hydroxocobalamin

Classification

Vitamin (form of vitamin B12)

Indications

CCP: Patients with known cyanide ingestion

CCP: Patients from enclosed space fires with altered levels of consciousness

Contraindications

Allergy to hydroxocobalamin

Adult dosages

CCP: All indications

70 mg/kg IV. Typical adult dose is 5 g for a 71 kg person.
Second half-dose may be given depending on the severity of the poisoning, or the clinical response to treatment

Pediatric Considerations And Dosing

Follow weight-based dosing

CCP: All indications

70 mg/kg IV.
Second half-dose may be given depending on the severity of the poisoning, or the clinical response to treatment

Mechanism Of Action

Hydroxocobalamin binds directly with cyanide molecules, which prevents cyanide binding to cellular mitochondria

Pharmocokinetics

Following IV administration:

Onset: Immediate
Half-life: 24-48 hours

Excretion is in the urine

Adverse Effects

Hydroxocobalamin may cause a temporary reddish discoloration of the skin, plasma, urine, and mucous membranes. These changes last for approximately two to three days.

Overdose

Single doses of hydroxocobalamin are safe in all patients not allergic to vitamin B12.

Warning And Precautions

Hydroxocobalamin may interfere with co-oximetry measurements, complicating the assessment of victims of smoke inhalation who may suffer from both cyanide and carbon monoxide poisoning.