Adult Dosing
Minimal or moderate North American crotalid envenomation
- Initial dose: 4-6 vials IV over 1 hr; observe patients for up to 1 hr following the completion of this first dose to determine if initial control of the envenomation has been achieved
- Repeat an additional dose of 4-6 vials IV until there is an initial control of the envenomation syndrome
- After achieving an initial control, administer additional 2-vial doses IV q6 hrs for up to 18 hrs (3 doses)
- May administer additional 2-vial doses, if indicated, based on the patient’s clinical course
Notes:- Initiate administration as soon as possible after crotalid snakebite in patients developing signs of progressive envenomation
- Administer infusion slowly over the first 10 minutes at a 25-50 mL/hour rate with careful observation for any allergic reaction. Increase the infusion rate to the full 250 mL/hour rate until completion if no such reaction develops. Closely monitor patients during therapy
- Additionally, supportive and adjunctive therapy may be necessary
Pediatric Dosing
Minimal or moderate North American crotalid envenomation
- Initial dose: 4-6 vials IV over 1 hr; observe patients for up to 1 hr following the completion of this first dose to determine if initial control of the envenomation has been achieved
- Repeat an additional dose of 4-6 vials IV until there is an initial control of the envenomation syndrome
- After achieving an initial control, administer additional 2-vial doses IV q6 hrs for up to 18 hrs (3 doses)
- May administer additional 2-vial doses, if indicated, based on the patient’s clinical course
Notes:- Initiate administration as soon as possible after crotalid snakebite in patients developing signs of progressive envenomation
- Administer infusion slowly over the first 10 minutes at a 25-50 mL/hour rate with careful observation for any allergic reaction. Increase the infusion rate to the full 250 mL/hour rate until completion if no such reaction develops. Closely monitor patients during therapy
- Additionally, supportive and adjunctive therapy may be necessary
[Outline]
See Supplemental Patient Information
- Risk of coagulopathy exists in many victims of viper envenomation due to the ability of the snake venom to interfere with the blood coagulation cascade. Recurrent coagulopathy characterized by decreased fibrinogen, decreased platelets, and elevated prothrombin time have been reported. Recurrent coagulation abnormalities were noted only in patients who experienced coagulation abnormalities during their initial hospitalization. Optimal dosing for complete prevention of recurrent coagulopathy has not been determined. Because antivenin crotalidae immune fab ovine polyvalent exhibits a shorter persistence in the blood than crotalid venoms that can leak from depot sites over a longer period of time, repeat dosing to prevent or treat such recurrence may be essential
- Recurrent coagulopathy may persist for 1-2 weeks or more. Monitor patients experiencing coagulopathy for signs and symptoms of recurrent coagulopathy for up to 1 week or longer. During this period, carefully assess the need for re-treatment with antivenin crotalidae immune fab ovine polyvalent and use of any type of anticoagulant or anti-platelet drug
- Patients having allergies to papain, chymopapain, other papaya extracts, or the pineapple enzyme bromelain may be at risk for an allergic reaction. Certain dust mite allergens and some latex allergens share antigenic structures with papain and patients having these allergies may be allergic to papain
- Neurological and renal toxicities related to high dose and acute exposures to methyl mercury, which is a component of this product, have been reported
- Severe hypersensitivity reactions, including anaphylaxis and anaphylactoid reactions, may occur during therapy; discontinue infusion and initiate appropriate emergency treatment if such reactions occur
- Injection of heterologous animal proteins may cause severe acute and delayed hypersensitivity reactions and a possible febrile response to immune complexes formed by animal antibodies and neutralized venom components
- Inform patients of the possibility of an anaphylactic reaction and consider close patient monitoring and readiness with IV therapy using epinephrine and diphenhydramine hydrochloride during the infusion of antivenin crotalidae immune fab ovine polyvalent
- On occurrence of an anaphylactic reaction during the infusion, terminate administration of this drug at once and institute appropriate treatment. Patients with known allergies to sheep protein may be particularly at risk for an anaphylactic reaction
- Carefully monitor patients treated with this product for signs and symptoms of an acute allergic reaction and treat with appropriate emergency medical care (e.g., epinephrine, intravenous antihistamines and/or albuterol)
- Follow-up patients for signs and symptoms of delayed allergic reactions or serum sickness and treat appropriately if indicated
- Reactions during the infusion, such as fever, low back pain, wheezing and nausea are often related to the rate of infusion and can be controlled by decreasing the rate of administration of the solution
- Exercise caution when administering a repeat course of treatment with this product for a subsequent envenomation episode
Cautions: Use cautiously in:
- Hypersensitivity to latex
- Hypersensitivity to dust mites
- Prior use of antivenin crotalidae immune fab ovine polyvalent
- Conditions associated with coagulation defects (cancer, diarrhea, collagen disease, elevated temperature, hepatic disorders, hyperthyroidism, CHF, vitamin K deficiency, poor nutritional state, and steatorrhea)
Supplemental Patient Information
- Advise patients to promptly report to their physician if they experience any signs and symptoms of delayed allergic reactions or serum sickness after hospital discharge
- Advise patients to contact their physician immediately on experiencing unusual bruising or bleeding (e.g., nosebleeds, excessive bleeding after brushing teeth, appearance of blood in stools or urine, excessive menstrual bleeding, petechiae, excessive bruising or persistent oozing from superficial injuries) after hospital discharge
Pregnancy Category:C
Breastfeeding: Safety unknown; manufacturer advises caution.
Pricing data from www.DrugStore.com in U.S.A.
- CroFab SOLR [Vial] (SAVAGE)
2 = $4687.76
6 = $13837.91
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
