antivenom stonefish (Australia) [IM]

Adult Dosing

Stonefish envenoming

Initial: For 1-2 punctures 2000 U, for 3-4 punctures 4000 U, and for 5 or more punctures 6000 U IM x1
If the initial dose is insufficient to control the effects of the venom and the identity of the stonefish is assured, consider repeating the initial dose of antivenom as necessary

Note:

Give by IV infusion in extreme cases after diluting the antivenom 1:10 in an intravenous solution
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 hrs following antivenom administration
If severe anaphylaxis is seen post antivenom administration, discontinue therapy, administer O₂ and adrenaline (1:1000) IM at the following doses:

Pediatric Dosing

Stonefish envenoming

Initial: For 1-2 punctures 2000 U, for 3-4 punctures 4000 U, and for 5 or more punctures 6000 U IM x1
If the initial dose is insufficient to control the effects of the venom and the identity of the stonefish is assured, consider repeating the initial dose of antivenom as necessary

Note:

Give by IV infusion in extreme cases after diluting the antivenom 1:10 in an intravenous solution
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 hrs after 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 adrenaline is seen, administer adrenaline (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

[Outline]

Indications ⬆ ⬇

Treatment of patients who, following envenoming by a stonefish, have systemic manifestations or severe edema and pain which do not respond to first aid measures

Contraindications ⬆ ⬇

Hypersensitivity to any of the ingredients of the product
Instances where there is no clear evidence of stonefish envenoming with serious toxic effects

Black Box Warnings ⬆ ⬇

Dosing Adjustment ⬆ ⬇

Renal Dose Adjustment

Hepatic Dose Adjustment

Warnings/Precautions ⬆ ⬇

Therapy may cause infectious diseases due to the transmission of infective agents. Physicians must remain alert to this possibility and communicate the same to the patients
Do not apply tourniquets or compression immobilization bandages around stonefish wounds to avoid local pain and tissue damage
Therapy may cause severe allergic reactions, including anaphylactic shock in patients who are atopic or who have previously received equine serum. A syringe already loaded with 1:1000 adrenaline must be available during antivenom therapy
Suspend therapy if anaphylaxis occurs and administer oxygen and inject 1:1000 adrenaline intramuscularly; may repeat after 5 minutes if required
Patients with severe systemic envenoming must be handled in an ICU, if possible
Delayed serum sickness manifested by fever, cutaneous eruptions, arthralgia, lymphadenopathy and albuminuria has been reported with use of animal-derived antivenoms. Such reaction may usually appear 8-13 days after antivenom use, but can occur as early as 12 hrs following a second injection of horse protein

Pregnancy/Breast Feeding ⬆ ⬇

Pregnancy Category:NR

Breastfeeding: Safety unknown.

Adverse Reactions ⬆ ⬇

Clinical Pharmacology ⬆ ⬇

Antivenom; prepared from the plasma of horses immunized with the venom of stonefish; contains specific antibodies against the toxic substances in the venom of the stonefish
Metabolism: Unknown
Excretion: Unknown
Half-life: Unknown

Brands and Availability ⬆ ⬇