Drug Shortage: Hydroxocobalamin kit (CYANOKIT)
Overview:
- Production of hydroxocobalamin kits was temporarily suspended due to an investigation into a possible deviation relating to a risk of microbial contamination.
- Lot number 2413, expiry date 30-Oct-2026 was manufactured during this time period and is potentially impacted.
- Based on risk assessment provided by the manufacturer, Health Canada has made the decision to authorize distribution of the affected batch as the risk of microbial contamination is considered minimal.
Note the following guidelines:
- Reserve hydroxocobalamin for patients with clinical signs of acute intoxication in a context suggestive of exposure to cyanide: cardiac arrest, shock, respiratory distress, coma, high lactic acidemia (>8 mmol/L)
- Hydroxocobalamin should not be used in the absence of hypoxia.
- Any signs/symptoms suggestive of systemic infection should trigger blood cultures and antibiotic therapy.
Supply of hydroxocobalamin kit (CYANOKIT) is constrained and conservation measures need to be implemented in order to avoid stock depletion.
Effective immediately: hydroxocobalamin is to be restricted for use in clinical situations requiring antidote for cyanide poisoning. Alternative treatment to consider for vasoplegic syndrome or refractory hypotension is methylene blue at a suggested dose of 1.5 to 2 mg/kg IV administered once over 20 to 60 minutes.
Please not that serotonin syndrome may occur in patients taking serotonergic agents and concomitant use of methylene blue.
Thank you for your support of the ongoing efforts to manage drug supply issues.
For questions, please contact your site pharmacy or please contact Rizwan Ahmed at or Libby Gair at
Submitted by: Pharmacy Program