Does amyl nitrite have a role in the management of pre-hospital mass casualty cyanide poisoning?

Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists
Ophir Lavon, Yedidia Bentur

Abstract

Amyl nitrite has been recommended as a cyanide antidote for several decades. Its antidotal properties were initially attributed to induction of methemoglobin and later to a nitric oxide mediated hemodynamic effect. The ease of administration and alleged rapid clinical effect would recommend its wide use in the pre-hospital management of mass casualty cyanide poisoning; yet there are concerns regarding the use of amyl nitrite for this indication. Review the data on amyl nitrite in cyanide poisoning and evaluate its efficacy and safety in mass casualty cyanide poisoning. A literature search utilizing PubMed, Toxnet, textbooks in toxicology and pharmacology, and the bibliographies of the articles retrieved identified 17 experimental studies and human reports on the use of amyl nitrite in cyanide poisoning, and 40 additional articles on amyl nitrite's properties and adverse effects. One paper was excluded as it was a conference abstract with limited data. The antidotal properties of amyl nitrite were attributed initially to induction of methemoglobinemia and later to nitric oxide mediated vasodilation. Animal studies on the use of amyl nitrite in cyanide poisoning are limited, and their results are inconsistent, which makes their e...Continue Reading

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Citations

Dec 19, 2014·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Ophir Lavon
Jun 8, 2012·Emergency Medicine Australasia : EMA·Michael C ReadeUNKNOWN Australian Resuscitation Council
Sep 21, 2013·Pharmaceutical Biology·Rahul BhattacharyaSaurabh Shrivastava
Feb 5, 2015·Journal of Medicinal Chemistry·Adriano ChanGerry R Boss
Feb 29, 2020·Drug Design, Development and Therapy·Anna Stene HurtsénKristofer F Nilsson
Mar 16, 2017·BMC Pharmacology & Toxicology·Ophir LavonArik Eisenkraft
Dec 5, 2020·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Ophir LavonArik Eisenkraft

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