This information is intended for use by health professionals
Dicobalt Edetate Injection 300mg
Each ampoule contains 300mg Dicobalt Edetate INN (15mg/ml)
Dicobalt Edetate Injection is a specific antidote for acute cyanide poisoning. In view of the difficulty of certain diagnosis in emergency situations, it is recommended that Dicobalt Edetate Injection only be given when the patient is tending to lose or has lost consciousness. The product should not be used as a precautionary measure.
Cyanide poisoning must be treated as quickly as possible and intensive supportive measures must be instituted: clear airways and adequate ventilation are essential. 100% oxygen should be administered concurrently with Dicobalt Edetate.
Expert advice on the treatment of poisoning is available at the local poisons centre.
One 300mg ampoule intravenously over approximately one minute. If the patient shows inadequate response, a second ampoule may be given. If there is no response after a further five minutes, a third ampoule may be administered.
Each ampoule of Dicobalt Edetate Injection may be followed immediately by 50ml Glucose Intravenous Infusion BP 500g/l.
When the patient's condition is less severe but in the physician's judgement still warrants the use of Dicobalt Edetate Injection, the period over which the injection is given should be extended to 5 minutes.
There is no clinical experience of the use of Dicobalt Edetate Injection in children. As with adults the dose required will be related to the quantity of cyanide ingested.
There is no clinical evidence of the use of Dicobalt Edetate Injection in the elderly, but there is no reason to believe that the dosage schedule should be different from that for adults.
There is a reciprocal antidote action between cyanide and cobalt. Thus in the absence of cyanide, Dicobalt Edetate Injection itself is toxic. It is therefore essential that the product only be used in cases of cyanide poisoning. When the patient is fully conscious, it is unlikely that the extent of poisoning warrants the use of Dicobalt Edetate Injection.
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The initial effects of Dicobalt Edetate Injection are vomiting, a fall in blood pressure and compensatory tachycardia. After this the patient should recover.
Signs and symptoms - these may be due to cobalt toxicity or to an anaphylactic type reaction, which may be dramatic. Oedema (particularly of the face and neck), vomiting, chest pain, sweating, hypotension, cardiac irregularities and rashes may occur.
Treatment - intensive supportive therapy is required.
Cyanide blocks intracellular respiration by binding to cytochrome oxidase. Dicobalt Edetate Injection forms a stable complex with the cyanide thereby acting as an antidote.
Only very limited data are available. Intravenous infusion of Dicobalt Edetate Injection is likely to result in rapid distribution in the extracellular fluid compartment. Excretion is entirely via the kidneys within 24 hours and it is not metabolised.
There are no pre-clinical data of relevance to the prescriber which are additional to that already included in other sections of the SPC.
Water for Injections
Store below 25°C away from light
Packs of six Ph.Eur Type I glass ampoules each containing 20ml of rose-violet coloured sterile pyrogen free solution
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