Sodium Thiosulphate

 

Indication Management of calciphylaxis (unlicenced indication) 
Dosage and administration FIRST DOSE 
Pre-treat with ondanstron 4mg IV 30 minutes prior to infusion.
Give 12.5g sodium thiosulphate IV over the last 30 minutes of dialysis.  Infuse into venous limb of dialysis circuit.Flush giving set with 0.9% sodium chloride once vial empty to ensure full dose is given.
Monitor for side effects (see below)

SUBSEQUENT DOSES 
Pre-treat with ondanstron 4mg IV 30 minutes prior to each infusion.
Give 25g sodium thiosulphate IV over the last 60 minutes of each dialysis thereafter.

Side effects Hypotension – monitor BP throughout infusion.  Usually only predicted following rapid infusion of large doses and should be self-limited and transient.

Nausea & vomiting – give ondansetron as above.  Continued nausea may require infusion being given over a longer period of time (e.g. over full dialysis session) or dose reduction.

Other reported side effects (from case reports):
Metabolic acidosis (correct on dialysis), Sinus congestion
Headache

Reconstitution instructions No reconstitution necessary
Additional information Continue course indefinitely and according to response.
No dose adjustment required for renal or hepatic impairment.
Concentration/strength Sodium thiosulphate 50% (12.5g in 50mls)  (unlicenced product)
Monitoring Continual blood pressure monitoring throughout test dose and first full dose (can be less frequent with subsequent doses if hypotension is not a problem)

U&Es plus calcium and phosphate- before 1st and 2nd doses, weekly thereafter.
PTH- monthly