Cyanide Antidotes in Development and New Methods to Monitor Cyanide Toxicity

Currently approved treatments for cyanide poisoning in the United States are hydroxocobalamin and the combination of sodium nitrite and sodium thiosulfate. All three agents must be given in relatively large volumes by intravenous injection. This chapter presents data on three drugs in development that are sufficiently potent and soluble to be administered in small volumes. The three drugs are cobinamide, a cyanide scavenger, dimethyltrisulfide (DMTS), a sulfur donor and a possible substrate for the two cyanide detoxifying enzymes rhodanese and 3-mercaptopyruvate sulfurtransferase (3-MPST), and sulfanegen, a 3-MPST substrate. Laboratory methods to detect cyanide poisoning in acute clinical care settings have been limited by the need for complex and time consuming assays. The potential clinical role for measuring exhaled breath hydrogen cyanide remains to be determined, and further investigations are ongoing regarding simplified detection methods.