Dicobalt edetate

How it works

The cobalt moiety binds cyanide ions to form stable, relatively non-toxic cobalt-cyanide complexes that are excreted, removing cyanide from the circulation.

Prescribing in practice

• Reserve strictly for confirmed or strongly suspected severe cyanide poisoning, as it is itself toxic and can cause serious reactions (including hypotension and facial/laryngeal oedema) if given in the absence of cyanide.
• Administer only by clinicians familiar with its use, with full resuscitation facilities immediately available.
• Follow with supportive care and consider intravenous glucose, as recommended in current prescribing references.

Monitoring

Monitor cardiovascular status, airway and clinical response continuously during and after administration.

Counselling the patient

• Explain to the team that this is an emergency antidote for cyanide poisoning.
• Highlight the risk of severe adverse reactions if cyanide exposure is not actually present.
• Ensure resuscitation equipment is to hand before use.

Evidence & guidelines

Dicobalt edetate is recognised as an antidote for severe cyanide poisoning, with use guided by national poisons information services such as TOXBASE.