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But how do they work

If clinical suspicion of cyanide poisoning is high, CYANOKIT should be administered without delay 1 CYANOKIT can be used to treat multiple sources of cyanide poisoning, including smoke inhalation and ingestion 1 Hydroxocobalamin, the active ingredient in CYANOKIT, has been used in France since the 1980s, was formally licensed there in 1996, and was approved in the United States in 2006 to treat known or suspected cyanide poisoning 6,7 Clinical Experience Randomized clinical trials in humans are not possible due to ethical considerations, therefore evidence in controlled trials of the effectiveness of hydroxocobalamin for the treatment of cyanide poisoning was obtained primarily from studies in animals

ISO 17034 describes competence and consistent operation requirements for reference material producers, reinforcing the broader point that documented identity, value assignment, and traceability matter in analytical-material workflows [15]

Because its a water-soluble vitamin, any excess that isnt used should be flushed from the body and not pose too much risk (not the case with fat-soluble vitamins like vitamin A)