How to Help Your Facility Secure Cyanokit in Stock: A Provider's Guide

The Cyanokit (hydroxocobalamin) shortage has put hospital pharmacists, EMS medical directors, fire department administrators, and emergency medicine physicians in a difficult position: how do you ensure your facility has the preferred cyanide antidote available when supply is limited and unpredictable?

This guide provides a practical, step-by-step framework for healthcare providers and administrators to secure available Cyanokit stock, establish backup protocols, and maintain readiness for cyanide emergencies throughout 2026.

Step 1: Conduct an Immediate Inventory Audit

Before reaching out to suppliers, get a clear picture of your current situation. For hospital pharmacy teams, this means:

• Count current Cyanokit vials on hand (ED crash carts, pharmacy storage, ICU supply)
• Check lot numbers against the FDA advisory for impacted batches
• Verify expiration dates on current stock
• Assess whether you have 0.2-micron in-line filters in stock for use with impacted batches
• Audit backup antidote supply (Nithiodote, sodium thiosulfate, sodium nitrite)

For EMS agencies and fire departments: verify which units carry Cyanokit, quantity per unit, and last restock date.

Step 2: Contact Your Primary Distributor Immediately

Your hospital's primary pharmaceutical distributor — McKesson, Cardinal Health, or AmerisourceBergen — is the first call to make. When you reach your account representative, ask these specific questions:

1. What is the current inventory status of Cyanokit (hydroxocobalamin for injection, 5g)?
2. Is there an allocation cap per facility, and what is our current allocation?
3. Are there any released batches available that require the 0.2-micron filter workaround?
4. What is the expected next available ship date?
5. Can we be placed on a priority back-order list?

Step 3: Contact SERB Pharmaceuticals Directly

SERB Pharmaceuticals manufactures Cyanokit and operates a Specialty Solutions Center dedicated to emergency medicine procurement support. Contact them at 1-877-377-3784 or through cyanokit.com. In shortage situations, manufacturers sometimes maintain direct allocation channels for high-priority institutional buyers that aren't available through standard distribution.

When contacting SERB, explain your facility's role (trauma center, Level I ED, regional EMS medical authority, etc.) and your patient volume. Facilities with documented high-risk populations or regional emergency response responsibilities may receive preferential allocation.

Step 4: Check Specialty EMS Suppliers

For EMS agencies and fire departments, specialty EMS pharmaceutical suppliers often have separate allocation channels from hospital distributors. Life-Assist (life-assist.com) and Bound Tree Medical (boundtree.com) are two major suppliers that specifically service prehospital providers. Contact both during a shortage, as their availability may differ from McKesson's.

Step 5: Use medfinder to Search Across Multiple Channels

When manual distributor calls aren't yielding results, medfinder for providers can significantly reduce the time spent searching. medfinder contacts pharmacies and suppliers across its network to determine which ones have Cyanokit in stock near you — giving your pharmacy team actionable sourcing information without the burden of making dozens of individual calls.

Step 6: Update Your Shortage Management Protocol

While sourcing, simultaneously update your facility's shortage management protocol:

• Define conservation criteria: Reserve available Cyanokit for high-probability cyanide poisoning cases (plasma lactate >10 mmol/L, confirmed or highly suspected cyanide exposure).
• Update order sets: Modify cyanide poisoning order sets to reflect alternative antidote options and shortage-specific dosing guidance.
• Staff education: Ensure ED nurses, pharmacists, and residents know the alternative protocols and drug incompatibilities.
• Poison Control integration: Post the poison control number (1-800-222-1222) prominently in resuscitation areas and ensure protocols specify calling poison control for real-time guidance.

Step 7: Establish Ongoing Monitoring

Once you've secured initial supply, establish a recurring monitoring process:

• Weekly check of ASHP Drug Shortage Center for Cyanokit updates
• Quarterly antidote stock audit across all storage locations
• Maintain active backorder status with at least two distributors simultaneously
• Subscribe to FDA MedWatch safety alerts for ongoing Cyanokit-related communications

For more context on why Cyanokit is hard to find and the clinical decision-making when it is unavailable, see our related articles on the Cyanokit shortage update and Cyanokit alternatives for providers.