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Cyanide Poisoning and How to Treat It Using CYANOKIT (Hydroxocobalamin for Injection) 5G

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Cyanide Poisoning and How to Treat It Using CYANOKIT (hydroxocobalamin for injection) 5g 1. CYANOKIT (single 5-g vial) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011. Please see Important Safety Information on slides 3-4 and full Prescribing Information for CYANOKIT starting on slide 33. CYANOKIT is a registered trademark of SERB Sarl, licensed by Meridian Medical Technologies, Inc., a Pfizer company. Copyright © 2015 Meridian Medical Technologies, Inc., a Pfizer company. All rights reserved. CYK783109-01 November/2015. Indication and Important Safety Information……………………………………………………………………………….………..…..3 . Identifying Cyanide Poisoning……………………………………………………………………………………………………………….…………….….5 . How CYANOKIT (hydroxocobalamin for injection) Works……………………………………………………………….12 . The Specifics of CYANOKIT…………………………………………………………………………………………………………………………….………17 . Administering CYANOKIT………………………………………………………………………………………………………………………………..……….21 . Storage and Disposal of CYANOKIT…................................................................................................................................26 . Grant Information for CYANOKIT……………………………………………………………………………………………………………………....30 . Full Prescribing Information………………………………………………………………………………………………….………………………………33 Please see Important Safety Information on slides 3-4 and full Prescribing Information for CYANOKIT starting on slide 33. CYANOKIT (hydroxocobalamin for injection) 5 g for intravenous infusion is indicated for the treatment of known or suspected cyanide poisoning. If clinical suspicion of cyanide poisoning is high, CYANOKIT should be administered without delay. Cyanide poisoning may result from inhalation, ingestion, or dermal exposure. Prior to administration of CYANOKIT, smoke-inhalation victims should be assessed for: exposure to fire or smoke in an enclosed area; presence of soot around the mouth, nose, or oropharynx, and altered mental status. In addition to CYANOKIT, treatment of cyanide poisoning must include immediate attention to airway patency, adequacy of oxygenation and hydration, cardiovascular support, and management of any seizure activity. Use caution in the management of patients with known anaphylactic reactions to hydroxocobalamin or cyanocobalamin. Consideration should be given to use of alternative therapies, if available. Allergic reactions may include: anaphylaxis, chest tightness, edema, urticaria, pruritus, dyspnea, and rash. Allergic reactions including angioneurotic edema have also been reported in postmarketing experience. (Important Safety Information continued on next slide) 3 Please see Important Safety Information on slides 3-4 and full Prescribing Information for CYANOKIT starting on slide 33. Substantial increases in blood pressure may occur following CYANOKIT therapy. Elevations in blood pressure (≥180 mmHg systolic or ≥110 mmHg diastolic) were observed in approximately 18% of healthy subjects receiving hydroxocobalamin 5 g and 28% of subjects receiving 10 g. Usage may interfere with some clinical laboratory evaluations. Also, because of its deep red color, hydroxocobalamin may cause hemodialysis machines to shut down due to an erroneous detection of a "blood leak." This should be considered before hemodialysis is initiated in patients treated with hydroxocobalamin. Due to potential photosensitivity, patients should avoid direct sun until erythema resolves. There are no adequate and well-controlled studies of CYANOKIT in pregnant women. CYANOKIT should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Safety and effectiveness of CYANOKIT have not been established in pediatric patients. The most common adverse reactions (>5%) included transient chromaturia, erythema, rash (predominantly acneiform), increased blood pressure, nausea, headache, decreased lymphocyte percentage, and injection site reactions. 4 Please see Important Safety Information on slides 3-4 and full Prescribing Information for CYANOKIT starting on slide 33. ► Click for Table of Contents . Sources of cyanide poisoning include hydrogen cyanide and its salts, cyanogenic plants, aliphatic nitriles, and prolonged exposure to sodium nitroprusside.1 . Cyanide poisoning may result from inhalation, ingestion, or dermal exposure to various cyanide-containing compounds, including smoke from closed-space fires.1 Cyanide poisoning may result from inhalation, ingestion, or dermal exposure. Prior to administration of CYANOKIT, smoke-inhalation victims should be assessed for: exposure to fire or smoke in an enclosed area; presence of soot around the mouth, nose, or oropharynx, and altered mental status. In addition to CYANOKIT, treatment of cyanide poisoning must include immediate attention to airway patency, adequacy of oxygenation and hydration, cardiovascular support, and management of any seizure activity. 1. CYANOKIT (single 5-g vial) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011. 2. Guidotti T. Acute cyanide poisoning in prehospital care: new challenges, new tools for intervention. Prehosp Disaster Med. 2005;21(2):s40-s48. 6 Please see Important Safety Information on slides 3-4 and full Prescribing Information for CYANOKIT starting on slide 33. The presence and extent of cyanide poisoning are often initially unknown1 . There is no widely available, rapid, confirmatory cyanide blood test1 . Treatment decisions must be made on the basis of clinical history and signs and symptoms of cyanide intoxication1 . Plasma lactate level could be monitored, as it increases proportionally with the degree of cyanide poisoning, but it is not a definite diagnostic tool1 . If cyanide poisoning is suspected, treatment should not be delayed to obtain a plasma lactate concentration.1,2,3 Use caution in the management of patients with known anaphylactic reactions to hydroxocobalamin or cyanocobalamin. Consideration should be given to use of alternative therapies, if available. Allergic reactions may include: anaphylaxis, chest tightness, edema, urticaria, pruritus, dyspnea, and rash. Allergic reactions including angioneurotic edema have also been reported in postmarketing experience. 1. CYANOKIT (single 5-g vial) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011. 2. Baud FJ, Borron SW, Mégarbane B, et al. Value of lactic acidosis in the assessment of the severity of acute cyanide poisoning. Crit Care Med. 2002;30(9):2044-2050. 3. Lawson-Smith P, Jansen EC, Hyldegaard O. Cyanide intoxication as part of smoke inhalation–a review on diagnosis and treatment from the emergency perspective. Scand J Trauma Resusc Emerg Med. 2011;19:1-5. 7 Please see Important Safety Information on slides 3-4 and full Prescribing Information for CYANOKIT starting on slide 33. Although carbon monoxide is a well-known toxin in fire smoke, cyanide can be an overlooked danger.1 . Cyanide is often released when everyday items found in most homes and businesses combust, making smoke inhalation the most common cause of acute cyanide poisoning.2 . With signs and symptoms similar to carbon monoxide poisoning, cyanide poisoning can be difficult to recognize. 3 . Despite the similarities, quick diagnosis is essential, and that’s often up to emergency personnel.3 Substantial increases in blood pressure may occur following CYANOKIT therapy. Elevations in blood pressure (≥180 mmHg systolic or ≥110 mmHg diastolic) were observed in approximately 18% of healthy subjects receiving hydroxocobalamin 5 g and 28% of subjects receiving 10 g. 1. Eckstein M, Maniscalco PM. Focus on smoke inhalation–the most common cause of acute cyanide poisoning. Prehosp Disaster Med. 2006;21(2):s49-s55. 2. Guidotti T. Acute cyanide poisoning in prehospital care: new challenges, new tools for intervention. Prehosp Disaster Med. 2005;21(2):s40-s48. 3. CYANOKIT (single 5-g vial) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011. 4. Stevens J. Carbon monoxide and cyanide poisoning in smoke inhalation victims: a review. Trauma Report. 2015;1-19. 8 Please see Important Safety Information on slides 3-4 and full Prescribing Information for CYANOKIT starting on slide 33. Common Signs and Symptoms of Cyanide and Carbon Monoxide Poisoning3,4 Usage may interfere with some clinical laboratory evaluations. Also, because of its deep red color, hydroxocobalamin may cause hemodialysis machines to shut down due to an erroneous detection of a "blood leak." This should be considered before hemodialysis is initiated in patients treated with hydroxocobalamin. Due to potential photosensitivity, patients should avoid direct sun until erythema resolves. 1. Eckstein M, Maniscalco PM. Focus on smoke inhalation–the most common cause of acute cyanide poisoning. Prehosp Disaster Med. 2006;21(2):s49-s55. 2. Guidotti T. Acute cyanide poisoning in prehospital care: new challenges, new tools for intervention. Prehosp Disaster Med. 2005;21(2):s40-s48. 3. CYANOKIT (single 5-g vial) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011. 4. Stevens J. Carbon monoxide and cyanide poisoning in smoke inhalation victims: a review. Trauma Report. 2015;1-19. 9 Please see Important Safety Information on slides 3-4 and full Prescribing Information for CYANOKIT starting on slide 33. Cyanide poisoning in smoke-inhalation victims should be suspected if the following manifestations are present*1,2: Exposure to fire or smoke in an enclosed area Soot around mouth, nose, or back of mouth Altered mental status (eg, confusion, disorientation) *List may not
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