Sodium nitrite and sodium thiosulfate: Drug information

(For additional information see "Sodium nitrite and sodium thiosulfate: Patient drug information" and see "Sodium nitrite and sodium thiosulfate: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)

ALERT: US Boxed Warning

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 should be used with caution in patients in whom the diagnosis of cyanide poisoning is uncertain.

Closely monitor patients to ensure adequate perfusion and oxygenation during treatment with sodium nitrite. Consider alternative therapeutic approaches in patients known to have diminished oxygen or cardiovascular reserve (eg, smoke inhalation victims, preexisting anemia, cardiac or respiratory compromise), and in those at higher risk of developing methemoglobinemia (eg, congenital methemoglobin reductase deficiency) as they are at greater risk of potentially life-threatening adverse events related to the use of sodium nitrite.

Brand Names: US

Nithiodote

Pharmacologic Category

Antidote

Dosing: Adult

Note: Consultation with a clinical toxicologist or poison control center is highly recommended.

Cyanide poisoning

Cyanide poisoning: IV: Note: Administer sodium nitrite first, followed immediately by the administration of sodium thiosulfate.

Sodium nitrite: 300 mg (10 mL of a 3% solution); may repeat at one-half of the original dose if symptoms of cyanide toxicity return

Alternatively, in patients who are unable to tolerate significant methemoglobinemia (eg, patients with comorbidities that compromise oxygen delivery, such as heart disease, lung disease), dosing may be based on hemoglobin levels (when rapid bedside testing is available) to prevent fatal methemoglobinemia; see table (Berlin, 1970):

Hemoglobin Level (g/dL)	Dose of 3% Sodium Nitrite Solution (maximum dose: 10 mL)
7	0.19 mL/kg
8	0.22 mL/kg
9	0.25 mL/kg
10	0.27 mL/kg
11	0.3 mL/kg
12	0.33 mL/kg
13	0.36 mL/kg
14	0.39 mL/kg

Sodium thiosulfate: 12.5 g (50 mL of a 25% solution); may repeat at one-half the original dose if symptoms of cyanide toxicity return

Note: Monitor the patient for 24 to 48 hours; if symptoms return, repeat both sodium nitrite and sodium thiosulfate at one-half the original doses.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

No dosage adjustment provided in manufacturer’s labeling; however, renal elimination of sodium nitrite and sodium thiosulfate is significant and risk of adverse effects may be increased in patients with renal impairment.

Dosing: Hepatic Impairment: Adult

No dosage adjustment provided in the manufacturer’s labeling (has not been studied).

Dosing: Older Adult

Refer to adult dosing; use with caution due to the likelihood of decreased renal function.

Dosing: Pediatric

(For additional information see "Sodium nitrite and sodium thiosulfate: Pediatric drug information")

Note: Dosing in pediatric patients expressed in multiple units (mg/kg, mL/kg, mL/m²), use extra caution. Consultation with a clinical toxicologist or poison control center is highly recommended.

Cyanide poisoning

Cyanide poisoning: Note: Hydroxocobalamin is the preferred cyanide antidote; if hydroxocobalamin is unavailable, then sodium nitrite may be used in conjunction with sodium thiosulfate. Administer sodium nitrite first, followed immediately by the administration of sodium thiosulfate (Howland 2019). Sodium nitrite is generally discontinued for methemoglobin levels >30%.

Sodium nitrite (30 mg/mL, 3%): Infants, Children, and Adolescents: IV: 6 mg/kg (0.2 mL/kg or 6 to 8 mL/m² of a 3% solution); maximum dose: 300 mg (10 mL of a 3% solution) (Howland 2019; manufacturer's labeling). Monitor patients for 24 to 48 hours; if symptoms return, repeat both sodium nitrite and sodium thiosulfate at one-half the original doses.

Dosage adjustment for patients who are unable to tolerate significant methemoglobinemia (eg, patients with comorbidities that compromise oxygen delivery, such as heart disease, lung disease, etc): Hemoglobin-dependent dosing (when rapid bedside testing is available) to prevent fatal methemoglobinemia (Berlin 1970):

Dosing Based on Hgb Level
Hemoglobin Level (g/dL)	Dose of 3% Sodium Nitrite Solution (Maximum dose: 10 mL/dose)
7	0.19 mL/kg
8	0.22 mL/kg
9	0.25 mL/kg
10	0.27 mL/kg
11	0.3 mL/kg
12	0.33 mL/kg
13	0.36 mL/kg
14	0.39 mL/kg

Sodium thiosulfate: Infants, Children, and Adolescents: IV: 250 to 412.5 mg/kg (1 to 1.65 mL/kg of a 25% solution); maximum dose: 12.5 g/dose (50 mL of a 25% solution) (Holstege 2019; Howland 2019; Mintegi 2013; manufacturer's labeling). Monitor the patient for 24 to 48 hours; if symptoms return, repeat both sodium nitrite and sodium thiosulfate at one-half the original doses.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling; however, renal elimination of sodium nitrite and sodium thiosulfate is significant and risk of adverse effects may be increased in patients with renal impairment.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied).

Adverse Reactions

See individual agents.

Contraindications

There are no contraindications listed within the manufacturer’s labeling.

Warnings/Precautions

Concerns related to adverse effects:

• Hypotension: [US Boxed Warning]: Sodium nitrite may cause severe hypotension resulting in diminished oxygen-carrying capacity; serious adverse effects may occur at doses less than twice the recommended therapeutic dose. Monitor for adequate perfusion and oxygenation; ensure patient is euvolemic. Use with caution in patients where the diagnosis of cyanide poisoning is uncertain, patients with pre-existing diminished oxygen or cardiovascular reserve (eg, smoke inhalation victims [due to the presence of carbon monoxide], anemia, substantial blood loss, and cardiac or respiratory compromise) and in patients who may be susceptible to injury from vasodilation; the use of hydroxocobalamin is recommended in these patients.

• Methemoglobinemia: [US Boxed Warning]: Sodium nitrite may cause methemoglobin formation resulting in diminished oxygen-carrying capacity; serious adverse effects may occur at doses less than twice the recommended therapeutic dose. Monitor for adequate perfusion and oxygenation. Use with caution in patients where the diagnosis of cyanide poisoning is uncertain, patients with pre-existing diminished oxygen or cardiovascular reserve (eg, smoke inhalation victims [due to the presence of carbon monoxide], anemia, substantial blood loss, and cardiac or respiratory compromise), and in patients at greater risk for developing methemoglobinemia (eg, congenital methemoglobin reductase deficiency); the use of hydroxocobalamin is recommended in these patients. Use with caution with concomitant medications known to cause methemoglobinemia (eg, nitroglycerin, phenazopyridine). Sodium nitrite is generally discontinued for methemoglobin levels >30%. Intravenous methylene blue and exchange transfusion have been used to treat life-threatening methemoglobinemia.

Disease-related concerns:

• Anemia: Use with caution; patients with anemia will form more methemoglobin. Dosage reduction in proportion to oxygen-carrying capacity is recommended.

• Glucose-6-phosphate dehydrogenase deficiency: Patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, especially children, are at an increased risk for hemolytic crisis following sodium nitrite administration; consider alternative treatment options (eg, hydroxocobalamin) if possible. Monitor for an acute drop in hematocrit; exchange transfusion may be necessary.

• Renal impairment: Use with caution; sodium nitrite and sodium thiosulfate undergo substantial renal excretion. Risk for adverse events may be increased.

Special populations:

• Older adult: Use with caution due to the likelihood of decreased renal function.

• Fire victims: Fire victims may present with both cyanide and carbon monoxide poisoning. In this scenario, hydroxocobalamin is the agent of choice for cyanide intoxication since the induction of methemoglobinemia (due to sodium nitrite) is contraindicated until carbon monoxide levels return to normal due to the risk of severe tissue hypoxia. Methemoglobinemia decreases the oxygen-carrying capacity of hemoglobin and the presence of carbon monoxide prevents hemoglobin from releasing oxygen to the tissues. In these patients, sodium thiosulfate may be used alone to promote the clearance of cyanide; however, hydroxocobalamin is still the preferred cyanide antidote because sodium thiosulfate has a slow onset of action.

• Pediatric: Methemoglobin reductase, which is responsible for converting methemoglobin back to hemoglobin, has reduced activity in pediatric patients. In addition, infants and young children have some proportion of fetal hemoglobin which forms methemoglobin more readily than adult hemoglobin. Therefore, pediatric patients (eg, neonates and infants <6 months of age) are more susceptible to excessive nitrite-induced methemoglobinemia. Hydroxocobalamin will circumvent this problem and may be a more effective and rapid alternative.

• Sulfite hypersensitivity: The presence of sulfite hypersensitivity should not preclude the use of this medication.

Other warnings/precautions:

• Appropriate use: Cyanide poisoning: Due to the risk for serious adverse effects, use with caution in patients where the diagnosis of cyanide poisoning is uncertain. However, if clinical suspicion of cyanide poisoning is high, treatment should not be delayed. Signs of cyanide poisoning may include altered mental status, cardiovascular collapse, chest tightness, mydriasis, nausea/vomiting, dyspnea, hyper-/hypotension, plasma lactate ≥8 mmol/L. Treatment of cyanide poisoning should include external decontamination and supportive therapy. Consider immediate consultation with a poison control center at 1-800-222-1222.

• Initiation of treatment: Collection of pretreatment blood cyanide concentrations does not preclude administration and should not delay administration in the emergency management of highly suspected or confirmed cyanide toxicity. Pretreatment levels may be useful as postinfusion levels may be inaccurate.

• Return of symptoms: Patients receiving treatment for acute cyanide poisoning must be monitored for return of symptoms for 24-48 hours; repeat treatment (one-half the original dose) should be administered if symptoms return.

• Smoke inhalation: Use nitrites cautiously in patients with cyanide poisoning related to smoke inhalation because methemoglobinemia and carboxyhemoglobinemia (from carbon monoxide) may worsen oxygen-carrying capacity.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Injection, solution [combination package]:

Nithiodote: Sodium nitrite 300 mg/10 mL (10 mL) and sodium thiosulfate 12.5 g/50 mL (50 mL)

Pricing: US

Kit (Nithiodote Intravenous)

300MG/10ML&12.5 gm/50 mL (per mL): $3.80

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Adult

IV: Administer via slow IV injection as soon as possible after diagnosis of acute, life-threatening cyanide poisoning. Administer sodium nitrite first at a rate of 2.5 to 5 mL/minute, followed immediately by sodium thiosulfate over 10 to 30 minutes (Howland 2019); some recommend slower administration of sodium nitrite (≥5 minutes [ATSDR 2022]). Decrease the rate of infusion in the event of significant hypotension. Simultaneous administration of blood products (whole blood, packed red cells, platelet concentrate, and/or fresh frozen plasma) should preferentially be done using separate lines (use contralateral extremities if peripheral lines are used).

Administration: Pediatric

IV: Administer both components undiluted via slow IV injection as soon as possible after diagnosis of acute, life-threatening cyanide poisoning. Administer sodium nitrite at a rate of 2.5 to 5 mL/minute, followed immediately by the administration of sodium thiosulfate over 10 to 30 minutes (Howland 2011; Howland 2019). Decrease rate of infusion in the event of significant hypotension, nausea, or vomiting. Simultaneous administration of blood products (whole blood, packed red cells, platelet concentrate, and/or fresh frozen plasma) should preferentially be done using separate lines (use contralateral extremities if peripheral lines are used).

Use: Labeled Indications

Cyanide poisoning: Treatment of acute, life-threatening cyanide poisoning.

Note: The preferred antidote for the treatment of acute cyanide poisoning is hydroxocobalamin, especially in patients who have concurrent carbon monoxide poisoning (eg, smoke inhalation), significant anemia, or G6PD deficiency (Anseeuw 2013). Sodium nitrite and sodium thiosulfate should be considered only if hydroxocobalamin is unavailable, there is a contraindication to the use of hydroxocobalamin, or if the patient has a known sensitivity to hydroxocobalamin or vitamin B₁₂ analogues. Consider consultation with a clinical toxicologist or poison control center.

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider therapy modification

Amisulpride (Oral): May enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy

Arginine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Blood Pressure Lowering Agents: May enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Bromperidol: May diminish the hypotensive effect of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Risk X: Avoid combination

Dapsone (Topical): May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Risk C: Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy

Herbal Products with Blood Pressure Lowering Effects: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Foslevodopa. Risk C: Monitor therapy

Local Anesthetics: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Risk C: Monitor therapy

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Methemoglobinemia Associated Agents: May enhance the adverse/toxic effect of Sodium Nitrite. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Risk C: Monitor therapy

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nitric Oxide: May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Risk C: Monitor therapy

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Prilocaine: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Prilocaine. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Management: Monitor patients for signs of methemoglobinemia (e.g., hypoxia, cyanosis) when prilocaine is used in combination with other agents associated with development of methemoglobinemia. Avoid lidocaine/prilocaine in infants receiving such agents. Risk C: Monitor therapy

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Silodosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Pregnancy Considerations

Sodium nitrite causes methemoglobin formation resulting in diminished oxygen-carrying capacity; fetal hemoglobin may be more susceptible to excessive nitrite-induced methemoglobinemia; however, cyanide crosses the placenta; untreated cyanide poisoning may cause maternal and fetal death.

In general, medications used as antidotes should take into consideration the health and prognosis of the mother; antidotes should be administered to pregnant patients if there is a clear indication for use and should not be withheld because of fears of teratogenicity (Bailey 2003). However, sodium nitrite/sodium thiosulfate is not the preferred treatment of cyanide toxicity (Anseeuw 2013) and other treatments may be preferred for use during pregnancy (Culnan 2018). Therapies not associated with methemoglobinemia should be considered when available.

Breastfeeding Considerations

It is not known if sodium nitrite or sodium thiosulfate is present in breast milk; however, cyanide and thiocyanate are present in breast milk.

When cyanide poisoning is the indication for use of sodium nitrite/sodium thiosulfate, clinicians should be aware that the breastfed infant may have been exposed to cyanide and may also require treatment for cyanide poisoning (De Capitani 2017); consultation with a clinical toxicologist or poison control center is highly recommended.

Due to the potential for serious adverse reactions in the breastfed infant, breastfeeding is not recommended by the manufacturer; it is not known when breastfeeding can be resumed following maternal treatment.

Monitoring Parameters

Monitor for at least 24-48 hours after administration; blood pressure and heart rate during and after infusion; hemoglobin/hematocrit; co-oximetry; serum lactate levels; venous-arterial PO₂ gradient; serum methemoglobin and oxyhemoglobin. Pretreatment cyanide levels may be useful diagnostically, but if the patient is acutely ill, do not delay sodium nitrite therapy while awaiting laboratory results.

Mechanism of Action

Sodium nitrite: Promotes the formation of methemoglobin which competes with cytochrome oxidase for the cyanide ion. Cyanide combines with methemoglobin to form cyanomethemoglobin, thereby freeing the cytochrome oxidase and allowing aerobic metabolism to continue.

Sodium thiosulfate: Serves as a sulfur donor in rhodanese-catalyzed formation of thiocyanate (much less toxic than cyanide).

Pharmacokinetics (Adult Data Unless Noted)

Sodium nitrite:

Onset of action (Methemoglobinemia):

Peak methemoglobin concentration, mean (7%): 30 to 60 minutes.

Half-life (conversion of methemoglobin to normal hemoglobin): ~55 minutes.

Metabolism: To ammonia and other metabolites.

Excretion: Urine (~40% as unchanged drug).

Sodium thiosulfate:

Distribution: IV: V_d: Thiosulfate: 0.15 L/kg (Howland 2011); Thiocyanate: 0.25 L/kg.

Half-life elimination: Thiosulfate: ~3 hours (Howland 2011); Thiocyanate: 2.7 days; Prolonged with renal impairment to ~9 days.

Excretion: Urine (~20% to 50% thiosulfate as unchanged drug).

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(GB) United Kingdom: Nithiodote;
(PR) Puerto Rico: Nithiodote;
(TW) Taiwan: Nithiodote

Agency for Toxic Substances and Disease Registry (ATSDR). Medical Management Guidelines for Hydrogen Cyanide (HCN). https://www.atsdr.cdc.gov/MHMI/mmg8.pdf. Updated October 21, 2014. Accessed February 2, 2022.
Anseeuw K, Delvau N, Burillo-Putze G, et al. Cyanide poisoning by fire smoke inhalation: a European expert consensus. Eur J Emerg Med. 2013;20(1):2-9. doi:10.1097/MEJ.0b013e328357170b [PubMed 22828651]
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Bebarta VS, Brittain M, Chan A, et al. Sodium nitrite and sodium thiosulfate are effective against acute cyanide poisoning when administered by intramuscular injection. Ann Emerg Med. 2016;69(6):718-725. [PubMed 28041825]
Bebarta VS, Pitotti RL, Borys DJ, et al, “Seven Years of Cyanide Ingestions in the USA: Critically Ill Patients are Common, but Antidote Use is Not,” Emerg Med J, 2011, 28(2):155-8. [PubMed 20511644]
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Culnan DM, Craft-Coffman B, Bitz GH, et al. Carbon monoxide and cyanide poisoning in the burned pregnant patient: an indication for hyperbaric oxygen therapy. Ann Plast Surg. 2018;80(3 suppl 2):S106-S112. doi:10.1097/SAP.0000000000001351 [PubMed 29461288]
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De Capitani EM, Borrasca-Fernandes CF, Branco Pimenta M, et al. Suicide attempt with acetonitrile ingestion in a nursing mother. Clin Toxicol (Phila). 2017;55(8):929-933. doi:10.1080/15563650.2017.1324977 [PubMed 28494173]
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Holstege CP, Kirk MA. Cyanide and hydrogen sulfide. In: Nelson LS, Howland, MA, Lewin NA, et al, eds. Goldfrank's Toxicologic Emergencies. 11th ed. McGraw-Hill Education; 2019.
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Mintegi S, Clerigue N, Tipo V, et al. Pediatric cyanide poisoning by fire smoke inhalation: a European expert consensus. Toxicology Surveillance System of the Intoxications Working Group of the Spanish Society of Paediatric Emergencies. Pediatr Emerg Care. 2013;29(11):1234-1240. [PubMed 24196100]
Nithiodote (sodium nitrite/sodium thiosulfate) [prescribing information]. Scottsdale, AZ: Hope Pharmaceuticals; January 2021.
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Sodium nitrite and sodium thiosulfate: Drug information