Cyanokit Shortage Update: What Patients Need to Know in 2026

Cyanokit — the brand name for hydroxocobalamin for injection, the primary antidote for cyanide poisoning — has been in an active shortage since late 2024. As of 2026, supply remains constrained, raising legitimate concerns for communities, emergency services, and patients who may be at risk of cyanide exposure.

Here's what you need to know about the current status of the shortage, what's causing it, and what it means for emergency care in your community.

Current Shortage Status (2026)

As of late 2025 and into 2026, the American Society of Health-System Pharmacists (ASHP) lists Cyanokit as having "limited availability" in the United States. This designation means the drug is not entirely off the market, but supply is significantly below normal demand levels, and many facilities are experiencing allocation constraints.

The shortage has no confirmed resolution date as of the publication of this article. This is an ongoing situation that emergency medicine professionals, hospital pharmacists, and EMS agencies are actively managing.

What Is Causing the Cyanokit Shortage?

The shortage was triggered by a quality defect identified at SERB Pharmaceuticals' contract manufacturing facility. Specifically, the investigation centered on concerns about sterility assurance and endotoxin content in manufactured batches of the product.

As a result, manufacturing was suspended while the investigation proceeded. The FDA subsequently issued guidance identifying impacted batch numbers and allowing certain batches to be released and used — with the precaution of using a 0.2-micron in-line filter during administration.

Because Cyanokit has only one manufacturer in the U.S. market — SERB Pharmaceuticals — any production disruption immediately affects the entire national supply. There is no generic version of the 5g IV formulation available to fill the gap.

What Does This Mean for Emergency Care?

Cyanokit is not a medication that patients take at home. It is administered in emergency situations — in hospital emergency rooms, ICUs, or by paramedics in the field. The shortage affects the ability of emergency departments and EMS agencies to stock this lifesaving antidote.

The most common cause of cyanide poisoning requiring Cyanokit is smoke inhalation from residential or commercial fires. When synthetic materials like carpeting, foam furniture, or plastics burn in enclosed spaces, they release hydrogen cyanide gas. Victims can develop severe cyanide toxicity rapidly, sometimes alongside carbon monoxide poisoning.

Hospitals and EMS agencies have adapted to the shortage by:

• Conserving available Cyanokit for high-probability cyanide poisoning cases
• Stocking Nithiodote (sodium nitrite + sodium thiosulfate) as a backup antidote
• Using released Cyanokit batches with a 0.2-micron in-line filter as per FDA guidance
• Updating clinical protocols for smoke inhalation treatment

Should Patients and Families Be Concerned?

For the general public, the most important thing to know is that cyanide poisoning is rare in everyday life, but fire safety remains critically important. If you are in a building fire, the dangers include not just burns and smoke inhalation of particulates, but also cyanide and carbon monoxide toxicity from burning synthetics.

Emergency departments continue to have protocols and alternative antidotes in place even during the Cyanokit shortage. Treatment is still available — it may simply involve the alternative antidote (Nithiodote or sodium thiosulfate) rather than hydroxocobalamin.

For individuals working in industries with cyanide exposure risk — such as electroplating, jewelry manufacturing, mining, or chemical production — it is worth confirming that your employer has updated emergency response protocols and available antidotes on site.

What Is Cyanokit Used For? (Quick Summary)

Cyanokit contains hydroxocobalamin — a specialized form of vitamin B12 that binds directly to cyanide ions in the bloodstream, forming a nontoxic compound (cyanocobalamin) that the kidneys excrete. It is given intravenously in emergency settings, with a standard starting dose of 5 grams (one vial) administered over 15 minutes. A second 5g dose may be given for severe cases, up to a maximum of 10g total.

How medfinder Helps During Shortages

Drug shortages like the Cyanokit situation are exactly the kind of challenge that medfinder was built to address. For healthcare providers trying to locate available supply in their region, medfinder contacts pharmacies, distributors, and facilities to find where a medication is in stock — without the hours of phone calls that a manual search would require. See our posts on how to find Cyanokit in stock and Cyanokit alternatives for providers for more detailed guidance.