Adult Dosing

Envenomation due to bite by a tiger, copperhead or black snake

• 1 vial [3000 U] diluted with Hartmann’s solution (1:10) should be administered slowly by IV infusion
• May require several vials of antivenom to control the effects in patients with severe systemic envenoming, especially if coagulopathy is seen

• Do not remove the splint and pressure bandage until antivenom is available for infusion, as removal can precipitate significant effects of systemic envenoming
• 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 (1:1000) 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

• Administer corticosteroid IV x 1, to avoid delayed serum sickness

Pediatric Dosing

Envenomation due to bite by a tiger, copperhead or black snake

• 1 vial [3000 U] diluted with Hartmann’s solution (1:5 or 1:10) IV should be administered slowly by IV infusion
• May require several vials of antivenom to control the effects in patients with severe systemic envenoming, especially if coagulopathy is seen

• Do not remove the splint and pressure bandage until antivenom is available for infusion, as removal can precipitate significant effects of systemic envenoming
• 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, to avoid delayed serum sickness

[Outline]

• Adult Dosing
• Pediatric Dosing

• Treatment of patients who exhibit manifestations of systemic envenoming due to bite by a tiger, copperhead, or black snake

Note:

• Also active against the venom of Collett’s snake and rough scaled snake

• 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 transmission of infectious diseases. Physicians must remain alert to this possibility and communicate the same to the patients
• 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 12 hrs in an ICU. Monitor such patients regularly for signs of neuromuscular impairment, coagulopathy, and myolysis
• 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
• Patients with severe systemic envenoming must be handled in an ICU
• Delayed serum sickness manifested by fever, cutaneous eruptions, arthralgia, lymphadenopathy, and albuminuria has been reported with 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

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; neutralizes the neurotoxin, coagulant, and myolytic toxin present in the venom of the tiger snake
• 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 tiger snake (generic)

• INJ: 3000 U/vial

[Outline]

Emergency/Critical Care

Antivenins

Snake