Hydroxocobalamin is approved and shall be prioritized for use in patients with known or suspected cyanide toxicity, including those with:
Significant smoke inhalation injuries accompanied by obtundation not explained by alcohol or other sedatives
Elevated carboxyhemoglobin levels
Associated metabolic acidosis
KEY POINT: During periods of drug shortage or limited supply, hydroxocobalamin must be restricted to treatment of confirmed or high-risk cyanide poisoning cases only.
The off-label use of hydroxocobalamin (e.g., refractory vasoplegia in cardiac surgery or critical care) should be limited due to a paucity of robust clinical evidence supporting efficacy.
Such use should be reserved for select cases where alternative options are not viable, and ideally discussed with Critical Care, Anesthesiology, or Pharmacy specialists.
Hydroxocobalamin is not recommended if injectable anticoagulants (e.g., heparin) are likely to be required within 24 hours due to laboratory monitoring limitations (see below).
KEY POINT: See lab test website for guidance on interference with common lab tests associated with hydroxocobalamin. Hydroxocobalamin may result in unpredictable or unmeasurable coagulation studies, including aPTT and PT/INR.
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Hydroxocobalamin Administration: Policy 900.4100
May have limited inventory. See Antidote Policy 916.3804
Hydroxocobalamin is approved and shall be prioritized for use in patients with known or suspected cyanide toxicity, including those with:
KEY POINT: During periods of drug shortage or limited supply, hydroxocobalamin must be restricted to treatment of confirmed or high-risk cyanide poisoning cases only.
The off-label use of hydroxocobalamin (e.g., refractory vasoplegia in cardiac surgery or critical care) should be limited due to a paucity of robust clinical evidence supporting efficacy.
KEY POINT: See lab test website for guidance on interference with common lab tests associated with hydroxocobalamin. Hydroxocobalamin may result in unpredictable or unmeasurable coagulation studies, including aPTT and PT/INR.