Adult Dosing

Envenomation due to stings from box jellyfish

• 1 vial [20,000 U] diluted with an intravenous solution (1:10) should be administered slowly by IV infusion; may repeat dose as necessary
• If IV administration is not practical, administer 3 vials undiluted by IM route at 3 separate sites

• Do not remove the splint and pressure bandage until antivenom is available for infusion, as removal can precipitate significant effects of systemic envenoming
• In case of severe systemic envenoming, initiate cardiopulmonary resuscitation and other first aid measures if indicated before giving antivenom
• Manage severe cases of systemic envenoming in an ICU
• Premedicate with 0.25 mL adrenaline (1:1000) SC and antihistamine IV to reduce the chance of anaphylactic shock
• Monitor patients for at least 6 hours after conclusion of antivenom infusion
• If severe anaphylaxis is seen post antivenom administration, discontinue therapy, administer O₂ and adrenaline (1:1000) IM at following doses:
• Small adults (<50 kg): 0.25 mL
• Average adults (50-100 kg): 0.5 mL
• Large adults (>100 kg): 0.75 mL
• If no or minimal response to initial IM dose of adrenaline is seen, administer the same dose of adrenaline (diluted to 1:10000) slowly into an IV line; repeat q5 minutes as per patient response

• Administer corticosteroid IV x 1 or orally for 4-5 days to those receiving multiple vials of antivenom to avoid delayed serum sickness
• Use only once and discard any residue

Pediatric Dosing

Envenomation due to stings from box jellyfish

• 1 vial [20,000 U] diluted with an intravenous solution (1:10 or 1:5 for small children) should be administered slowly by IV infusion; may repeat dose as necessary
• If IV administration is not practical, administer 3 vials undiluted by IM route at 3 separate sites

• Do not remove the splint and pressure bandage until antivenom is available for infusion, as removal can precipitate significant effects of systemic envenoming
• In case of severe systemic envenoming, initiate cardiopulmonary resuscitation and other first aid measures if indicated before giving antivenom
• Manage severe cases of systemic envenoming in an ICU
• Premedicate with 0.25 mL adrenaline (1:1000) SC and antihistamine IV to reduce the chance of anaphylactic shock
• Monitor patients for at least 6 hours after conclusion of antivenom infusion
• If severe anaphylaxis is seen post antivenom administration, discontinue therapy, administer O₂ and adrenaline (1:10000) IM at following doses:
• Children 12 yrs: 0.25 mL/yr of age
• If no or minimal response to initial IM dose of adrenaline is seen, administer the same dose of adrenaline (diluted to 1:10000) slowly into an IV line; repeat q5 minutes depending on response

• Administer corticosteroid PO x 4-5 days in order to avoid delayed serum sickness
• Use only once and discard any residue

• Treatment of patients who exhibit manifestations of systemic envenoming following stings from a box jellyfish (Chironex fleckeri) or who have extensive local involvement causing extreme pain which does not respond to routine analgesic therapy

• Hypersensitivity to any of the ingredients of the product
• Instances where there is no clear evidence of systemic envenoming or extensive local involvement with intractable pain

• N/A

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• During administration of medicinal products prepared from animal plasma, risk of infectious diseases due to the transmission of infective agents cannot be excluded. This possibility should be considered by the physicians and conveyed to patients who may receive the product. However, there have been no recorded cases of transmission of viruses by this antivenom
• Severe envenoming following extensive tentacle contact over one or more limbs can lead to death within 20 minutes
• Initiate cardiopulmonary resuscitation and other first aid measures before commencing antivenom therapy, in serious cases of envenoming which may cause cessation of respiration and cardiac arrest. Pour vinegar over the tentacles to prevent further dissemination of the venom from the nematocysts
• If the limb has been immobilized and a firm bandage applied, do not remove the bandage and splint until the patient is in hospital with appropriate antivenom treatment available as it may precipitate the systemic effects of the venom
• Manage serious cases of systemic envenoming in an intensive care unit
• During antivenom therapy, a syringe loaded with 1:1000 adrenaline must be readily available due to the potential for severe allergic reactions including anaphylactic shock owing to the animal serum present in this product. Anaphylactic reactions are commonly seen in patients who are atopic or who have previously received ovine serum. Patients who are at increased risk of such reactions should be premedicated with SC adrenaline and IV antihistamine
• Anaphylactoid reactions may also occur in patients previously not sensitized to ovine protein due to complement binding of antivenom. Appropriate dilution of antivenom may reduce this risk
• If anaphylaxis occurs, discontinue antivenom and initiate treatment with oxygen and adrenaline. In severe cases, IV antihistamines and corticosteroids may be given to reduce the chance of late reactions
• Restart therapy after considering the relative problems of envenoming and anaphylaxis
• Delayed serum sickness manifested by fever, cutaneous eruptions, arthralgia, lymphadenopathy and albuminuria has been reported with the use of animal-derived antivenoms. Such reaction may appear 8-13 days after antivenom use, but can occur as early as 12 hrs following a second injection of a similar animal protein. Also, such incidence of serum sickness is more with larger volumes of antivenom

Pregnancy Category:NR

Breastfeeding: Safety unknown.

• HYPERSENSITIVITY: Allergic reactions, anaphylactic shock, delayed serum sickness
• DERM: Urticaria, rash

• Venom-neutralizing globulin; exact mode of action is unknown; it may neutralize the toxins present in the box jellyfish venom
• Absorption: Unknown
• Metabolism: Unknown
• Excretion: Unknown
• Half-life: Unknown

US Trade Name(s)

• N/A

US Availability

• N/A

Canadian Trade Name(s)

• N/A

Canadian Availability

• N/A

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• Only generic available

Australian Availability

box jellyfish antivenom (generic)

• INJ: 20,000 units/vial

Emergency/Critical Care

Antivenins

Fish