Comprehensive medication guide to Cyanokit including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
Cyanokit is not covered by Medicare Part D. When administered in a hospital ED or inpatient setting, it may be reimbursed under Medicare Part A/B or commercial insurance as part of the facility claim. Workers' compensation typically covers the full cost for occupational cyanide exposures.
Estimated Cash Pricing
$1,031–$1,146 per 5g vial at retail pricing (brand only, no generic available). With SingleCare discount coupons, the price may be reduced to approximately $1,027 per vial. Medicare Part D does not cover Cyanokit as it is not dispensed at retail pharmacies.
Medfinder Findability Score
25/100
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Cyanokit is the brand name for hydroxocobalamin for injection — an FDA-approved emergency antidote for the treatment of known or suspected cyanide poisoning. It contains 5 grams of hydroxocobalamin, a form of vitamin B12, in a lyophilized (freeze-dried) powder that is reconstituted and administered intravenously.
Cyanokit is not a medication dispensed at retail pharmacies — it is stocked by hospital emergency departments, advanced life support EMS agencies, and fire departments. It is manufactured by SERB Pharmaceuticals and has been FDA-approved in the United States since 2006.
As of 2026, Cyanokit is in an active shortage listed by the American Society of Health-System Pharmacists (ASHP) as having "limited availability," due to a manufacturing quality issue at the contract manufacturer involving sterility assurance and endotoxin content concerns.
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Cyanide kills by binding cytochrome oxidase (cytochrome a3) in the mitochondrial electron transport chain, halting cellular energy production and forcing anaerobic metabolism. This causes a profound lactic acidosis and cellular hypoxia despite normal blood oxygen levels.
Hydroxocobalamin works by directly binding cyanide ions in a 1:1 molar ratio. Each hydroxocobalamin molecule displaces its hydroxo group (OH) from the central cobalt ion and replaces it with one cyanide ion, forming cyanocobalamin (vitamin B12) — a nontoxic compound that is excreted in the urine. This restores cellular aerobic respiration.
Hydroxocobalamin also binds nitric oxide, producing a vasoconstriction effect that can help correct the hypotension common in cyanide poisoning. This makes it the preferred antidote for smoke inhalation victims, who often have concurrent carbon monoxide poisoning — unlike the older alternative (sodium nitrite), which reduces the blood's oxygen-carrying capacity.
5 g (5,000 mg) — lyophilized powder for IV infusion
Single-vial starting dose; reconstitute with 200 mL 0.9% NaCl to 25 mg/mL dark red solution; infuse IV over 15 minutes
Cyanokit has a findability score of 25 out of 100, reflecting an active FDA shortage with widespread availability constraints. The shortage began in late 2024 due to a quality defect at SERB Pharmaceuticals' contract manufacturer, and as of 2026, it remains unresolved.
Cyanokit is not available at retail pharmacies. It is purchased through hospital pharmacy systems, specialty medical distributors (McKesson, Cardinal Health, AmerisourceBergen), specialty EMS suppliers (Life-Assist, Bound Tree Medical), and directly from SERB Pharmaceuticals. During the shortage, all of these channels face constrained allocations.
For healthcare providers working to locate available supply, medfinder contacts suppliers and facilities across its network to identify where Cyanokit is in stock in your region — saving significant time during shortage procurement.
Cyanokit is not a controlled substance and does not require DEA scheduling authorization. However, it is a prescription-only IV medication that must be ordered by a licensed prescriber and administered by trained medical personnel in an emergency clinical setting. It is not appropriate for outpatient, retail, or home use.
Providers who order and supervise Cyanokit administration include:
Telehealth is not an appropriate platform for Cyanokit prescription or administration. Cyanide poisoning is an immediate life-threatening emergency requiring 911 response and in-person emergency medical care. For any suspected cyanide poisoning, call 911 immediately and contact Poison Control at 1-800-222-1222.
No. Cyanokit (hydroxocobalamin for injection) is not a DEA scheduled controlled substance. It does not have abuse potential, does not require special DEA registration to prescribe, and is not subject to the dispensing, prescribing, or storage restrictions that apply to Schedule II–V medications.
Cyanokit is, however, a prescription-only medication that requires a physician's order for administration. It is stored in hospital pharmacy controlled storage areas not because of abuse concerns but because of its high cost, emergency-use designation, and the specialized training required for its administration and monitoring.
The following side effects were reported in more than 5% of patients treated with Cyanokit:
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Nithiodote (Sodium Nitrite + Sodium Thiosulfate)
FDA-approved two-drug cyanide antidote kit; second-line to Cyanokit; relatively contraindicated in smoke inhalation victims due to methemoglobinemia risk from sodium nitrite
Sodium Thiosulfate (alone)
Safer alternative for smoke inhalation victims when Cyanokit is unavailable; slower onset and limited monotherapy efficacy in severe poisoning; does not impair oxygen-carrying capacity
Sodium Nitrite (alone)
Older antidote that creates methemoglobin to sequester cyanide; rapid but dangerous in CO-exposed patients; generally second-line to Cyanokit
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Sodium Thiosulfate
majorChemical incompatibility when mixed in same IV line — forms inactive thiosulfatocobalamin. Must use separate IV lines if coadministering.
Sodium Nitrite
majorChemical incompatibility in same IV line. Must use separate IV access if coadministering.
Diazepam
majorChemical incompatibility in same IV line. Critical in cyanide poisoning cases where diazepam is needed for seizure management — use separate IV access.
Dopamine
majorChemical incompatibility in same IV line. Use separate IV access for hemodynamic support agents.
Dobutamine
majorChemical incompatibility in same IV line. Use separate IV access.
Cyanokit (hydroxocobalamin for injection) is a life-saving emergency antidote with a unique challenge: it is expensive, brand-only, has a single manufacturer, and is currently in an active shortage. For emergency departments, EMS agencies, and fire departments, maintaining access to this preferred cyanide antidote requires proactive procurement strategies, ongoing inventory monitoring, and readiness to implement alternative protocols when Cyanokit is unavailable.
For patients and community members, the most important takeaway is that emergency care for cyanide poisoning is still available even during the shortage — emergency departments have backup antidotes and updated protocols. For high-risk industrial workers, verifying that your workplace and local EMS have current antidote supply is a worthwhile safety check.
For providers and purchasing teams, medfinder offers a streamlined way to locate available Cyanokit supply across distributors and facilities in your region, saving critical procurement time during shortage conditions. Contact Poison Control (1-800-222-1222) for real-time clinical guidance in any cyanide poisoning emergency.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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