Shepherd Greene, Velez Larissa I
Medical College of Georgia, Augusta, GA 30912, USA.
Ann Pharmacother. 2008 May;42(5):661-9. doi: 10.1345/aph.1K559. Epub 2008 Apr 8.
To review the recently approved cyanide antidote, hydroxocobalamin, and describe its role in therapy.
Relevant publications were identified through a systematic search of PubMed using the MeSH terms and key words hydroxocobalamin and cyanide. This search was then limited to human studies published since 2000. Systematic searches were conducted through January 2008. References from identified articles were reviewed for additional pertinent human studies.
The literature search retrieved 7 studies on the safety and/or efficacy of hydroxocobalamin in humans. Four new studies were identified by the search and 3 studies were identified from the references.
Studies of antidote efficacy in humans are ethically and logistically difficult. A preclinical study demonstrated that intravenous doses of hydroxocobalamin 5 g are well tolerated by volunteer subjects. Hydroxocobalamin has been shown to reduce cyanide concentrations in controlled studies of nitroprusside therapy and in heavy smokers. A retrospective study of 14 acute cyanide poisonings also demonstrated hydroxocobalamin's safety and efficacy. Two studies examining hydroxocobalamin for smoke inhalation-associated cyanide poisoning indicated a possible benefit, but they are insufficient to establish definitive criteria for use in this setting. Randomized controlled trials of hydroxocobalamin and traditional cyanide antidotes (nitrites/thiosulfate) are lacking.
Cyanide poisoning can rapidly cause death. Having an effective antidote readily available is essential for facilities that provide emergency care. In cases of cyanide ingestion, both the nitrite/thiosulfate combination and hydroxocobalamin are effective antidotes. Hydroxocobalamin offers an improved safety profile for children and pregnant women. Hydroxocobalamin also appears to have a better safety profile in the setting of cyanide poisoning in conjunction with smoke inhalation. However, current data are insufficient to recommend the empiric administration of hydroxocobalamin to all victims of smoke inhalation.
回顾近期获批的氰化物解毒剂羟钴胺素，并描述其在治疗中的作用。
通过使用医学主题词（MeSH）术语以及关键词“羟钴胺素”和“氰化物”对PubMed进行系统检索，确定相关出版物。检索范围限定为2000年以来发表的人体研究。检索持续至2008年1月。对已识别文章的参考文献进行审查，以查找其他相关人体研究。
文献检索获得了7项关于羟钴胺素在人体中的安全性和/或有效性的研究。检索发现4项新研究，参考文献中识别出3项研究。
人体解毒剂疗效研究在伦理和后勤方面都存在困难。一项临床前研究表明，志愿者受试者静脉注射5 g羟钴胺素耐受性良好。在硝普钠治疗的对照研究以及重度吸烟者中，羟钴胺素已被证明可降低氰化物浓度。一项对14例急性氰化物中毒病例的回顾性研究也证明了羟钴胺素的安全性和有效性。两项研究探讨了羟钴胺素用于吸入烟雾相关氰化物中毒的情况，表明可能有益，但不足以确立在此情况下使用的明确标准。缺乏羟钴胺素与传统氰化物解毒剂（亚硝酸盐/硫代硫酸盐）的随机对照试验。
氰化物中毒可迅速导致死亡。对于提供急救护理的机构而言，随时有有效的解毒剂至关重要。在氰化物摄入的情况下，亚硝酸盐/硫代硫酸盐组合和羟钴胺素都是有效的解毒剂。羟钴胺素对儿童和孕妇具有更好的安全性。在与吸入烟雾相关的氰化物中毒情况下，羟钴胺素似乎也具有更好的安全性。然而，目前的数据不足以建议对所有吸入烟雾的受害者经验性使用羟钴胺素。
