Cyanide antidote (chelator)
Dicobalt edetate
Brand names: Kelocyanor
Adult dose
Dose: 300mg IV over 1 min, followed by 50mL 50% glucose IV; repeat once if no response
Route: IV
Frequency: 1–2 doses
Clinical pearls
- TOXBASE / NPIS: hydroxocobalamin (Cyanokit) is preferred first-line cyanide antidote — safer and effective without confirmed poisoning
- Dicobalt edetate reserved for confirmed severe cyanide poisoning when hydroxocobalamin unavailable
- UK National Poisons Information Service should be consulted (24h)
Contraindications
- Patients without confirmed cyanide poisoning (toxicity if given without cyanide)
- Hypersensitivity
Side effects
- Hypotension
- Tachycardia/arrhythmia
- Vomiting
- Anaphylaxis
- Cobalt toxicity if no cyanide present
- Facial oedema
Monitoring
- ECG
- BP
- ABG/lactate
- Conscious level
- Seizure activity
Reference: BNF; TOXBASE / NPIS; AAGBI; SmPC; https://bnf.nice.org.uk/drugs/dicobalt-edetate/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
- Syncope Assessment · ESC 2018 Syncope Guidelines; NICE NG109
- Acute Chest Pain · NICE CG95; ESC 2023 ACS Guidelines