Adult Dosing

Systemic envenoming following a bite by a death adder

• 1 vial [6000 U] diluted with Hartmann’s solution (1:10) should be administered slowly by IV infusion
• If severe coagulopathy or myocardial depression is present, patient may require several vials
• Max: 5 vials [30000 U]/dose

• Do not remove the splint and pressure bandage until antivenom is available for infusion, as removal can precipitate significant effects of systemic envenoming
• Manage severe cases of systemic envenoming in an ICU
• Monitor patients for at least 6 hours after the conclusion of the antivenom infusion
• Premedicate with 0.25 mL adrenaline (1:1000) SC and antihistamine IV to reduce the chance of anaphylactic shock
• 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 depending on response

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

Pediatric Dosing

Systemic envenoming following a bite by a death adder

• 1 vial [6000 U] diluted with Hartmann’s solution (1:10 or 1:5 for small children) should be administered slowly by IV infusion
• Children may become critically ill sooner and may require more antivenom
• Max: 5 vials [30000 U]/dose

• Do not remove the splint and pressure bandage until antivenom is available for infusion, as removal can precipitate significant effects of systemic envenoming
• Manage severe cases of systemic envenoming in an ICU
• Monitor patients for at least 6 hours after the conclusion of the antivenom infusion
• Premedicate with 0.25 mL adrenaline (1:1000) SC and antihistamine IV to reduce the chance of anaphylactic shock
• 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 a bite by a death adder

• Hypersensitivity to any of the ingredients of the product
• Instances where there is no clear evidence of systemic envenoming with the potential for serious toxic effects

• N/A

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Antivenoms derived from animal plasma carry the risk of infectious diseases due to transmission of infective agents. Physicians must remain alert to this possibility and communicate the same to the patients. But there have been no recorded cases of transmission of virus by this antivenom
• If a significant amount of venom has been introduced, evidence of poisoning is observed within 2 hrs, but may be delayed if appropriate first aid has been initiated with immobilization and a firm crepe bandage
• Avoid removal of the bandage and splint until antivenom is available, as it may precipitate the systemic effects of the venom
• Observe patients with suspected snake bite for at least 6 hrs and those with confirmed snake bite for at least 12 hrs in an ICU. Monitor such patients regularly for signs of neuromuscular impairment, coagulopathy, myolysis, and other abnormalities
• Manage severe cases of systemic envenoming in an ICU if possible
• Identification of specific venom at the bite site or in urine using venom detection kits is recommended for selection of the appropriate monovalent antivenom
• Antivenom may cause severe allergic reactions including anaphylactic shock, as it is made from animal serum. Keep a syringe loaded with adrenaline (1:1000) readily available, if such reactions occur
• Patients who are atopic or who have previously received equine serum are at a greater risk of anaphylactoid reactions. Premedication with SC adrenaline and IV antihistamine may reduce this risk to some extent
• Anaphylactoid reactions may also occur in patients previously not sensitized to equine 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.

• CNS: Headache
• DERM: Urticaria, rash
• HYPERSENSITIVITY: Allergic reactions, anaphylactic shock, delayed serum sickness
• MISC: Pyrexia, chills

• Venom-neutralizing globulins; prepared from the plasma of horses immunized with the venom of the death adder (Acanthophis antarcticus); neutralizes the neurotoxin present in the venom of death adder
• 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

antivenom death adder (generic)

• INJ: 6000 U/vial

Emergency/Critical Care

Antivenins

Snake