antivenom sea snake (Australia) [IV]

Adult Dosing

Antivenom

Start with 1,000 units slowly by IV infusion after dilution with Hartmann’s solution or normal saline (diluted 1 in 10); less severe cases, total of 3,000 units will control most patients
Severe envenoming: Start with 3,000-4,000 units; max dose: 10,000 units

Notes:

Do not remove the splint and pressure bandage if the patient has the affected limb immobilized, until the patient is in a unit where full resuscitation measures and antivenom are available
Manage severe cases of systemic envenoming in an ICU
Monitor patients for at least 6 hours after the conclusion of the antivenom infusion
Due to the potential for rapid anaphylactic reactions, keep a syringe loaded with 1:1,000 adrenaline readily available before starting antivenom infusion. Discontinue antivenom therapy on occurrence of such reactions; administer oxygen and inject 1:1,000 adrenaline IM at the following dose rates: small adults (<50 kg) 0.25 mL, average adults (50-100 kg) 0.5 mL, large adults (>100 kg) 0.75 mL. If there is no response to the IM dose of adrenaline, administer the same dose (diluted to 1:10,000) slowly into an IV line and repeat every 5 minutes as per the patient's response
Due to the possibility of delayed serum sickness following use of large volumes of foreign protein, it is advisable to administer a corticosteroid either by a single IV injection or orally for 4-5 days to those receiving multiple doses of antivenom
Use only once and discard any residue since this product contains no antimicrobial preservative

Pediatric Dosing

Antivenom

Start with 1,000 units slowly by IV infusion after dilution with Hartmann’s solution or normal saline (diluted 1 in 5 in small children); less severe cases, total of 3,000 units will control most patients
Severe envenoming: Start with 3,000-4,000 units; max dose: 10,000 units

Notes:

Do not remove the splint and pressure bandage if the patient has the affected limb immobilized, until the patient is in a unit where full resuscitation measures and antivenom are available
Manage severe cases of systemic envenoming in an ICU
Monitor patients for at least 6 hours after the conclusion of the antivenom infusion
Due to the potential for rapid anaphylactic reactions, keep a syringe loaded with 1:1,000 adrenaline readily available before starting antivenom infusion. Discontinue antivenom therapy on occurrence of such reactions; administer oxygen and inject 1:1,000 adrenaline IM (0.25 mL per year of age up to age 12). If there is no response to the IM dose of adrenaline, administer the same dose (diluted to 1:10,000) slowly into an IV line and repeat every 5 minutes as per the patient's response
Due to the possibility of delayed serum sickness following use of large volumes of foreign protein, it is advisable to administer a corticosteroid either by a single IV injection or orally for 4-5 days to children and to those receiving multiple doses of antivenom
Use only once and discard any residue since this product contains no antimicrobial preservative

[Outline]

Adult Dosing
Pediatric Dosing

Indications ⬆ ⬇

Treatment of patients who exhibit manifestations of systemic envenoming after a bite by a sea snake

Contraindications ⬆ ⬇

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

Black Box Warnings ⬆ ⬇

Dosing Adjustment ⬆ ⬇

Renal Dose Adjustment

Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment

Hepatic impairment: Dose adjustments not defined

Warnings/Precautions ⬆ ⬇

During administration of medicinal products prepared from animal plasma, possibility of infectious diseases due to transmission of infective agents cannot be excluded. This possibility should be considered by the physician and conveyed to patients who may receive the product. However, there have been no recorded cases of transmission of virus by this antivenom
It is advisable to observe all patients who have been bitten by a sea snake for at least 4 hours before administering antivenom because the potentially dangerous effects may be delayed for several hours, in some cases, or may occur after removing the pressure bandage
Manage severe cases of systemic envenoming in an ICU, if possible
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
During antivenom therapy, a syringe loaded with 1:1,000 adrenaline must be readily available due to the potential for severe allergic reactions including anaphylactic shock owing to the animal plasma present in the product. Anaphylactoid reactions are commonly seen in patients who are atopic or who have previously received equine serum. Some authorities recommend premedication with subcutaneous adrenaline and IV antihistamine in patients who are at an increased risk of anaphylactic reactions, but such use is controversial. Discontinue antivenom therapy on occurrence of anaphylactic reactions; administer oxygen and inject adrenaline 1:1,000 IM at the following dose rates: small adults (<50 kg) 0.25 mL, average adults (50-100 kg) 0.5 mL, large adults (>100 kg) 0.75 mL. For children up to 12 yrs, use 1:10,000 and inject 0.25 mL per year of age. If there is little or no response to the initial IM dose of adrenaline, administer the same dose (diluted to 1:10,000) slowly into an IV line and repeat every 5 minutes as per the patient's response
Restart therapy after considering the relative problems of envenoming and anaphylaxis
Following the use of animal derived antivenoms, delayed serum sickness can occur with common manifestations including fever, cutaneous eruptions, arthralgia, lymphadenopathy, and albuminuria. Arthritis, nephritis, neuropathy, and vasculitis may occur less commonly. Such condition usually appears 8-13 days after antivenom use but can occur as soon as 12 hours after a second injection of a similar animal protein. Also, such incidence of serum sickness is greater with larger volumes of antivenom

Pregnancy/Breast Feeding ⬆ ⬇

Pregnancy Category:NR

Breastfeeding: Safety unknown.

Adverse Reactions ⬆ ⬇

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

Clinical Pharmacology ⬆ ⬇

Antivenom; exact mechanism of action not known; neutralizes the effect of the venom of the sea snake
Absorption: Unknown
Metabolism: Unknown
Excretion: Unknown
Half-life: Unknown

Brands and Availability ⬆ ⬇