What Is Cyanokit? Uses, Dosage, and What You Need to Know in 2026

Cyanokit is the brand name for hydroxocobalamin for injection — a life-saving medication used to treat cyanide poisoning. Unlike most drugs discussed in the context of shortages, Cyanokit is not a daily medication or chronic treatment. It is an emergency antidote held in readiness by hospital emergency departments, EMS agencies, and fire departments, waiting for the rare but deadly moment when it is urgently needed.

In 2026, Cyanokit remains in an active shortage — making it even more important for healthcare providers, industrial safety teams, and the general public to understand what it is, when it's used, and why access to it matters.

Basic Facts About Cyanokit

• Brand name: Cyanokit
• Generic name: Hydroxocobalamin for injection
• Drug class: Cyanide antidote / Vitamin B12 analog
• Manufacturer: SERB Pharmaceuticals (licensed by BTG International Inc.)
• FDA approval: Approved in the U.S. in 2006 for treatment of known or suspected cyanide poisoning. Used in France since the 1980s; formally licensed there in 1996.
• Controlled substance: No. Cyanokit is not a DEA scheduled controlled substance.
• Available form: 5g lyophilized powder in a single 250 mL glass vial. No generic equivalent available.

What Is Cyanokit Used For?

Cyanokit has one FDA-approved indication: treatment of known or suspected cyanide poisoning. The FDA label states that if clinical suspicion of cyanide poisoning is high, Cyanokit should be administered without delay — even before laboratory confirmation.

Common causes of cyanide poisoning that may require Cyanokit treatment:

• Smoke inhalation from fires: The most common cause in the U.S. Burning synthetic materials (carpeting, foam, plastics, upholstery) in enclosed spaces releases hydrogen cyanide gas alongside carbon monoxide.
• Industrial exposure: Electroplating, jewelry manufacturing, mining, chemical production, and laboratory settings where hydrogen cyanide or cyanide salts are used.
• Ingestion of cyanide salts: Intentional or accidental ingestion of potassium cyanide, sodium cyanide, or other cyanide compounds.
• Prolonged sodium nitroprusside infusion: Sodium nitroprusside (used to manage hypertensive emergencies) releases cyanide ions as a metabolic byproduct, and cyanide toxicity can develop with prolonged or high-dose use.

Off-label uses: Medical literature supports hydroxocobalamin for vasoplegic syndrome (refractory hypotension following cardiac surgery or septic shock) and hydrogen sulfide poisoning, though these are not FDA-approved indications.

How Is Cyanokit Dosed and Administered?

Cyanokit is reconstituted and administered intravenously. Here is the standard adult dosing protocol:

1. Reconstitution: Add 200 mL of 0.9% Sodium Chloride (preferred), Lactated Ringer's, or 5% Dextrose to the 5g vial using the included transfer spike. The reconstituted solution will be dark red at 25 mg/mL.
2. Starting dose: 5g (one complete vial) administered by IV infusion over 15 minutes (approximately 15 mL/min).
3. Second dose (if needed): 5g IV over 15 minutes to 2 hours, depending on severity and clinical response. Maximum total dose: 10g (2 vials).
4. Concurrent supportive care: 100% oxygen, airway management, cardiovascular support, and seizure management should proceed simultaneously with antidote administration.

Who Is at Risk for Cyanide Poisoning?

While cyanide poisoning is rare in everyday life, certain populations face higher risk:

• Victims of residential or commercial building fires
• Firefighters and hazmat responders
• Workers in electroplating, mining, jewelry manufacturing, or chemical production
• Laboratory workers using cyanide compounds
• ICU patients receiving prolonged high-dose sodium nitroprusside infusions

Why the Current Cyanokit Shortage Matters

Cyanokit is in shortage in 2026 due to manufacturing quality issues at SERB Pharmaceuticals' contract facility. Because there is no generic equivalent and only one manufacturer, the shortage directly reduces the supply of the preferred cyanide antidote for emergency departments and EMS agencies nationwide. For healthcare organizations working to secure available supply, medfinder can help locate available Cyanokit without the burden of manual distributor calls. See our detailed posts on the Cyanokit shortage update and how to find Cyanokit in stock for more guidance.