# Hydroxocobalamin

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DRUG INFORMATION

  ADULT
    - ( 2.1 ) Dosing : The starting dose of CYANOKIT for adults is 5 g, administered by
      intravenous infusion over 15 minutes.
      Source: US FDA label for hydroxocobalamin (Cyanokit), section 'dosage and
      administration', retrieved 2026-08-29
    - One 5 g vial is a complete starting dose.
      Source: US FDA label for hydroxocobalamin (Cyanokit), section 'dosage and
      administration', retrieved 2026-08-29
    - ( 2.2 ) Depending upon the severity of the poisoning and the clinical response, a
      second dose of 5 g may be administered by intravenous infusion for a total dose of
      10 g.
      Source: US FDA label for hydroxocobalamin (Cyanokit), section 'dosage and
      administration', retrieved 2026-08-29

  CHILD
    - Safety and effectiveness of CYANOKIT have not been established in this population.
      In non-US marketing experience, a dose of 70 mg/kg has been used to treat
      pediatric patients.
      Source: US FDA label for hydroxocobalamin (Cyanokit), section 'pediatric use',
      retrieved 2026-08-29
    - In non-US marketing experience, a dose of 70 mg/kg has been used to treat
      pediatric patients.
      Source: US FDA label for hydroxocobalamin (Cyanokit), section 'pediatric use',
      retrieved 2026-08-29

  RENAL IMPAIRMENT
    - No adjustment of dose is required in elderly patients. 8.6 Renal Impairment The
      safety and effectiveness of CYANOKIT have not been studied in patients with renal
      impairment.
      Source: US FDA label for hydroxocobalamin (Cyanokit), section 'use in specific
      populations', retrieved 2026-08-29
    - ( 5.2 ) Risk of Renal Injury : Acute renal failure with acute tubular necrosis,
      renal impairment and urine calcium oxalate crystals have been reported following
      CYANOKIT therapy.
      Source: US FDA label for hydroxocobalamin (Cyanokit), section 'warnings and
      cautions', retrieved 2026-08-29
    - Allergic reactions including angioneurotic edema have also been reported in
      postmarketing experience. 5.3 Risk of Renal Injury Cases of acute renal failure
      with acute tubular necrosis, renal impairment, and urine calcium oxalate crystals
      have been reported.
      Source: US FDA label for hydroxocobalamin (Cyanokit), section 'warnings and
      cautions', retrieved 2026-08-29

  HEPATIC IMPAIRMENT
    - Hydroxocobalamin and cyanocobalamin are eliminated unchanged by the kidneys. 8.7
      Hepatic Impairment The safety and effectiveness of CYANOKIT have not been studied
      in patients with hepatic impairment.
      Source: US FDA label for hydroxocobalamin (Cyanokit), section 'use in specific
      populations', retrieved 2026-08-29

  PREGNANCY
    - Risk Summary Available data from cases reported in the published literature and
      postmarketing surveillance with CYANOKIT use in pregnant women are insufficient to
      identify a drug-associated risk for major birth defects, miscarriage, or adverse
      maternal and fetal outcomes.
      Source: US FDA label for hydroxocobalamin (Cyanokit), section 'pregnancy',
      retrieved 2026-08-29
    - There are risks to the pregnant woman and fetus associated with untreated cyanide
      poisoning (see Clinical Considerations) .
      Source: US FDA label for hydroxocobalamin (Cyanokit), section 'pregnancy',
      retrieved 2026-08-29
    - In animal studies, hydroxocobalamin administered to pregnant rats and rabbits
      during the period of organogenesis caused skeletal and soft tissue abnormalities,
      including alterations in the central nervous system, at exposures similar to human
      exposures at the therapeutic dose (see Data) .
      Source: US FDA label for hydroxocobalamin (Cyanokit), section 'pregnancy',
      retrieved 2026-08-29

  BREASTFEEDING
    - Treatment should not be withheld due to pregnancy ( 8.1 ) Lactation :
      Breastfeeding not recommended ( 8.2 ) 8.1 Pregnancy Risk Summary Available data
      from cases reported in the published literature and postmarketing surveillance
      with CYANOKIT use in pregnant women are insufficient to identify a drug-associated
      risk for major birth defects, miscarriage, or adverse maternal and fetal outcomes.
      Source: US FDA label for hydroxocobalamin (Cyanokit), section 'use in specific
      populations', retrieved 2026-08-29
    - It is unknown if similar findings would be observed in rats and rabbits if
      CYANOKIT was administered as a single dose during any critical period of
      development. 8.2 Lactation Risk Summary Breastfeeding is not recommended during
      treatment with CYANOKIT.
      Source: US FDA label for hydroxocobalamin (Cyanokit), section 'use in specific
      populations', retrieved 2026-08-29
    - Hydroxocobalamin and Vitamin B12 (which is formed when hydroxocobalamin combines
      with cyanide) are present in human milk.
      Source: US FDA label for hydroxocobalamin (Cyanokit), section 'use in specific
      populations', retrieved 2026-08-29
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