Snake Venom Antiserum

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Snake Venom Antiserum

antisnake

Snake Venom Antiserum Liquid and Lyophilized for India, Pakistan, Sri Lanka, Bangladesh and Nepal.

Description

Snake Venom Antiserum is a sterile preparation containing equine immunoglobulin fragments F (ab’) 2. Freeze dried powder is reconstituted in 10ml of sterile water for injection I.P. supplied along with the vial. Each ml has power to specifically neutralize the venoms of following species of snakes:

  • 0.60 mg of dried Indian Cobra (Naja naja) venom
  • 0.45 mg of dried Common Krait (Bangarus Caeruleus) venom
  • 0.60 mg of dried Russell’s Viper (Vipera Russelli) venom
  • 0.45 mg of dried Saw scaled Viper (Echis Carinatus) venom

Reconstitution of Lyophilized Antivenom

The antivenom is supplied in liquid and freeze-dried form as well. The freeze-dried powder is reconstituted with 10ml of sterile water for injection IP supplied with the pack. The whole content of freeze-dried powder dissolves into a clear colorless or pale yellow liquid.

Reconstituted anti-venom/liquid anti-venom is administered as soon as possible if clear-cut signs / symptoms of envenomation are evident. It can be administered in two ways:

  1. Intravenous injection: reconstituted or liquid antivenom is administered by slow intravenous injection (2ml per minute).
  2. Infusion: liquid or reconstituted antivenom is diluted in 5-10ml/kg body weight of isotonic saline or glucose.

All SVA is to be administered over 1 hour.

The patient should be closely monitored for 2 hours.

Local administration of antivenom in or around the bite-site is ineffective, painful, and may raise the intra-compartmental pressure, particularly in the digits and is not recommended.

In the case of bite by Cobra or Krait, there is creeping paralysis of eyelid muscles, staggering gait, difficulty in speaking, blurred vision, and drooping of head, accompanied by nausea and vomiting. These symptoms are due to the predominance of neurotoxins. Death may occur within minutes or several hours due to respiratory failure.

In the case of Russell’s Viper and Saw Scaled Viper, paralytic manifestations are uncommon (though they have occasionally been reported with Russell’s viper). The usual manifestations comprise of persistent pain and swelling of the bitten limb with blood oozing from the bite-site. There may be blister formation and necrosis. This is followed by generalized vascular injury with severe external and internal hemorrhage. Vomiting may occur. Death usually results from cardiovascular shock or renal failure.

Anaphylaxis is life-threatening, but if the correct protocol is followed, it can be dealt with effectively and treated. Anaphylaxis can be of rapid onset and can result into a life-threatening emergency very quickly. The patient should be monitored closely and at the first sign of any of the following, antivenom should be discontinued and 0.5mg of 1:1000 adrenaline must be administered intramuscularly: urticaria, itching, fever, chills or rigor, nausea, vomiting, diarrhea, abdominal cramps, tachycardia, hypotension, bronchospasm, and angioedema. Children must be given 0.01mg/kg body weight of adrenaline I/M.

In addition, to provide long-term protection against anaphylactoid reaction, 100mg of hydrocortisone and 10mg of H1 antihistamine can be given I/V. The dose for children is 0.2mg/kg of antihistamine I/V and 2mg/kg of hydrocortisone I/V.

If after 10 to 15 minutes, the patient’s condition has not improved, or if the condition is worsening, a second dose of 0.5 mg of adrenaline 1:1000 IM may be given. In the vast majority of cases, no more doses will be required. If there is hypotension or hemodynamic instability, I/V fluids should be given.

Once the patient has recovered, the antivenom can be restarted slowly for 10-15 minutes, keeping the patient under close observation. Then the normal drip rate can be resumed.

Sometimes serum sickness reactions may occur. But these usually take a few days to a week, and can be easily treated with oral antihistamines and corticosteroids (for e.g., prednisolone – adults 5mg – 6 hourly; child 0.7mg/kg/day)

Snakebite can cause moderate to severe pain at the bite site. This normally responds well to paracetamol. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) should not be administered, as they can exacerbate bleeding. Mild opiates (such as tramadol 50 mg) can be administered for severe pain.

Neostigmine is an anticholinesterase drug, which prolongs the action of acetylcholine, thereby reversing respiratory failure and neurotoxic symptoms. It is particularly effective in post-synaptic neurotoxins such as those of the Cobra.

Recommended dose: 0.5mg intramuscularly, half hourly, together with 0.6mg of atropine IV over an 8 hour period by continuous infusion. If there is no improvement in symptoms after one hour, neostigmine therapy should be stopped.

Renal failure may require dialysis therapy.

Store the freeze-dried preparation in a cool, dark place and avoid exposure to excessive heat. Reconstituted liquid should not be stored for long nor should be allowed to freeze. 10ml liquid vials should be stored between 2ºC and 8ºC. DO NOT FREEZE.

Snake venom antiserum I.P. is supplied as freeze-dried powder in glass vials. Water for injection is supplied in 10ml vials.

The antivenom is also supplied as 10ml liquid in glass vials.

Left over antivenom and used empty vials should be discarded as biomedical waste.

Snake Venom Antiserum for Africa


Description

Snake Venom Antiserum (African) is a sterile preparation contains equine immunoglobulin fragments F(ab’)2. Freeze dried powder is reconstituted in 10 ml of sterile water for Injection supplied along with the vial. Each ml has power of specifically neutralizing the venoms of following species of snakes.

  • Naja melanoleuca venom : 20LD50
  • Naja nigricollis venom : 20LD50
  • Naja haje venom : 25LD50
  • Dendroaspis polylepis venom : 25LD50
  • Dendroaspis viridis venom : 25LD50
  • Dendroaspis jamesoni venom : 25LD50
  • Bitis gabonica venom : 25LD50
  • Bitis arietans venom : 25LD50
  • Echis leucogaster venom : 25LD50
  • Echis ocellatus venom : 25LD50

The antitoxic equine Immunoglobulins and their derivatives are obtained from the serum of healthy equines immunized against venoms of above species of snakes.

Reconstitution of Lyophilised Serum
The antiserum is supplied in liquid as well as in freeze dried form. The freeze dried powder is reconstituted with 10 ml of sterile water for injection supplied with this pack. The whole content of freeze dried powder dissolves into a clear colorless or pale yellow liquid.

Reconstituted serum / liquid serum is administered as soon as possible after the snake bite by intravenous injection. The recommended initial dose is 20 ml by intravenous infusion. The injection should be given very slowly as 5 minutes by direct slow intravenous route (or) one hour by Infusion, diluted in 250 ml of infusion solution (0.9% Sodium Chloride solution or 5% glucose solution). A second dose may be given after one hour or two if the symptoms continue. Further doses are administered as required.

Snake bite victims must be given quick and positive first aid.
The patient must be removed to a well ventilated and quiet place and confidence infused. The patient must be assured that there is no reason to get alarmed.

Site of bite should be cleaned with water without rubbing and dressed up with antiseptics taking care not to rub the part. Bitten part should be immobilized. Apply a broad and firm antiseptic dressing / bandage. Take the patient to Hospital fast. Do not waste time on traditional treatment.

In case of neurotoxic (Naja and Dendroaspis) poisoning there is creeping paralysis of muscles of eyelids, staggering gait, incoordination of speech, paralysis of limbs, drooping of head accompanied by nausea and vomiting. These symptoms are due to the predominance of neurotoxins. Death may result within minutes or several hours due to respiratory failure.

In case of haemotoxic (Bitis and Echis) poisoning no paralysis is observed. The poisoning is characterized by persistent pain and swelling with oozing of blood from the bite. This is followed by generalized vascular injury. Severe internal haemorrhage with tenderness and vomiting may occur. Death may result by intravascular clotting.

Only Snake Venom Antiserum can neutralize the venom in circulation. Hence the serum should be injected as early as possible.

Before treating the patient, it should be enquired whether any serum injection was administered earlier and whether the patient has a history of asthma, eczema or drug allergy. Serum sensitivity test may be carried out by injecting 0.1 ml of serum in 1:10 dilution subcutaneously and by observing for half an hour for any reactions either local or general.

In allergic patients Snake Venom Antiserum should be given with antihistamines.

Administration of serum in snake bite victims has to be decided taking into consideration the severity of the condition of the patient. Urgency of treatment must override the danger of anaphylaxis. In such cases 1 ml of 1:1000 adrenaline may be given intramuscularly.

Serum sickness like reactions after the administration of heterologous proteins may occur about six days after the beginning of treatment. They consist of an inflammatory reaction due to complement activation and formation of immune complexes (type III hypersensitivity reaction). Clinical symptoms are fever, pruritus, rash or urticaria, adenopathy and arthralgia. Serum sickness is treated by administering corticosteroids (eg. 1 mg/kg of methylprednisolone followed by diminishing dosage) and antihistamines.

Sedatives and analgesics will relieve pain and nervousness in case of viper poisoning. Corticosteroids may be administered to minimize the serum and allergic reactions. Local sepsis may be prevented by antibiotic treatment. Normal saline or plasma infusions are recommended in near collapsing patients. In case of respiratory paralysis tracheotomy and positive pressure ventilation are additional measures.

Store the freeze dried preparation in a cool, dark place and avoid exposure to excessive heat. Reconstituted liquid should not be stored for long nor should be allowed to freeze. 10 ml liquid vials should be stored between 2ºC and 8ºC. DO NOT FREEZE.

Disposal

Left over Snake Venom Antiserum and used empty vials shall be disposed off as biomedical waste.

Snake Venom Antiserum (African) is supplied as freeze dried powder in glass vials. Water for Injection is supplied in 10 ml vials. Snake Venom Antiserum is also supplied as 10 ml liquid in glass vials.

VINS – Snake Venom Antiserum (Central Africa)
(Lyophilised/Liquid)

Description

Polyvalent Snake Venom Antiserum (Central Africa) is prepared from hyper-immunised equines against the venoms of the corresponding venomous snakes, namely:

  • Gaboon Viper (Bitisgabonica rhinoceros):    0.60 mg
  • Russell’s Viper (Vipera russelli):                     0.60 mg
  • Saw-scaled Viper (Echis carinatus):                0.45 mg

Plasma obtained from the hyper-immunized equines is enzyme refined, purified and concentrated. Each mL of the Snake Venom Antiserum (after reconstitution to 10 mL for lyophilised form) neutralizes not less than the following quantities of venoms when tested in mice:

Gaboon Viper 0.60 mg
Russell’s Viper 0.60 mg
Saw scaled Viper 0.45 mg

Snake envenomation is serious and could be life threatening.

The consequences of the action of snake venoms vary considerably based on the group to which the particular venom belongs. This, in turn depends upon the composition of the venom. In envenomation by viperid and crotalid snakes, venom (Cytotoxic) breaks down tissues destroying the red blood cells, e.g. Gaboon viper, Russell’s viper and Saw scaled viper.

In cases of viper envenomation (Gaboon viper, Russell’s viper and Saw scaled viper) the venom is characterized by a low content of neurotoxins, but large quantities of cytotoxins and these being proteins of high molecular weight, diffuse slowly within the tissues, hence they initially cause severe symptoms of poisoning in the region of the bite. Consequently, local symptoms are prominent and severe. There is great and persistent pain and intensive swelling at the bite site. The venom of the viper contains several enzymes which may possibly act synergistically to produce shock, spontaneous hemorrhages in the organs and tissues, acute necrosis and death. There is constant and incessant oozing of blood from the bite site. Sloughing too occurs permitting other infections.

The venom has a toxic effect on many different types of cells causing destruction of cell membranes. The constitutional symptoms are, therefore, characterized by hemorrhages, both external and internal. Hemorrhages in the abdomen are responsible for pain, tenderness and vomiting. Death is due to heart failure, but there is no paralysis.

Snake Venom Antiserum for Middle East and North Africa

antisnake

Snake venom antitoxin polyvalent is prepared from puried plasma of healthy horses, which have been hyperimmunized against venoms of the most dangerous snakes mentioned below. The antitoxin is puried from whole equine immune serum by pepsin digestion, controlled heating and caprylic acid precipitation, ultra-ltration followed by sterile ltration. It is intended for either intramuscular injection or intravenous infusion according to the severity of the condition.

Each mL upon reconstitution to 10 mL with Sterilised Water for Injections B.P. neutralises the snake

venoms of the following :

Naja haje
Naja nigricollis Cerastes
cerastes

Paraspecifically

  • Walterinnesia aegyptia
  • Bitis gabonica (East, Central and Southern Africa)
  • Echis carinatus
  • Macrovipera xanthina
  • Macrovipera lebetina
  • Vipera ammodytes
  • Cerastes vipera
  • Naja naje oxiana
  • Naja mossambica
  • Naja melanoleuca
  • Bitis arietans
  • Vipera palestinae

Preservative: Cresol B.P. <0.25% v/v

Clinical Pharmacology:

Symptoms and signs of snakebite depends on species, size and age of the biting snake, location and number of bites, depth of fang penetration, period of snake fangs on and volume of venom injected. They also depend on age, size and general health of the victim. Some snake species are neurotoxic, others are haemotoxic therefore, the clinical picture shows a wide range of symptoms and signs.

Grades of severity:

Grade 0 (no) No local or systemic manifestations.
Grade I(Minimal) Local swelling – no systemic manifestations normal laboratory results.
Grade II (Moderate) Local swelling – one or more systemic manifestations abnormal laboratory results.
Grade III(Severe) Marked local and systemic manifestations
with significant changes in laboratory results.

N.B:

Envenomation is a highly dynamic process which means that grade I state can very rapidly progress to grade III state.

The blood peak level is delayed up to 8 hours after intramuscular injection therefore; the intravenous route is preferred especially for moderate and severe envenomation and it is mandatory in venom induced shock. If adequate dose is given, cardiovascular effects respond within 10-20 minutes, spontaneous systemic bleeding stops within 15-30 minutes, blood coagulability is restored within about 6 hours and neurotoxic signs respond slowly after several hours. Snake bite victims must be given quick and positive rst aid.

Indication:

Treatment of envenomation caused by snake bites of any of the mentioned species in composition.

Dosage and Administration:

A skin test should be performed prior to administration of this product (see under skin test). The antivenom should be injected as soon as possible after the bite. It is given either intramuscularly or by intravenous drip according to severity of the condition. However, the subcutaneous route may be used in case of absence of anti-shock measures or an expert physician. The dose is neither age nor weight dependent however, it depends on severity of the condition with no recommended maximum dose. The total required dose is the amount needed to neutralize the venom as determined by cessation of progression of all components of envenomation (initial control).

For grade 0 :

No treatment is required as the drug should never be administered prophylactically in asymptomatic patients.

For grade I :

The recommended initial dose is 20-40 mL i.e., contents of 2-4 vials given by intramuscular route into a large muscle mass preferably the gluteal area, at different sites with care to avoid injury of nerve trunks.

For grades II and III :

The recommended initial dose is 40?60 mL, given by intravenous drip after diluting the product 5-10 times with 0.9% Sodium chloride or 5% Dextrose. The product should be infused slowly for the rst 10 minutes at a rate of 25?50 mL/h, with careful observation of any allergic reaction. If no reaction occurs, the infusion rate should be increased to the full 250 mL/h until completion.

The necessity of skin test is controversial however; it is preferable to be performed and interpreted prior to administration of antitoxin in order to be ready for early interference and close observation. In case of severe symptoms, it is not recommended to wait for 30 minutes to observe the skin test result therefore; it is advisable to initiate serum therapy with simultaneous injection of 0.5-1mL of 1:1000 adrenaline subcutaneous and parallel infusion of hydrocortisone and antihistamine to decrease the acute allergic reactions.

Steps and Interpretation:

Inject 0.1-0.2 mL (1:10 dilution) of antitoxin intradermally. A positive reaction occurs within 5-30 minutes manifested by a wheal with or without surrounding erythema accompanied by increased risk of systemic reactions in sensitive patients. If history is positive for allergy and the test is positive, administration may be dangerous especially if the test is accompanied by systemic allergic manifestations. In such instances, the benet of administration must be weighed against the risk of withholding the drug keeping in mind that severe envenomation can be fatal. The anti-shock measures should be loaded in syringes in such cases.

If history is negative for allergy and the result of test is negative, administer the drug, however, these do not rule out the possibility of an immediate reaction as 10% of false negative reactions have been reported.

N.B: Use of larger amount of skin test dose, increases the likelihood of false positive reactions.

Reconstitution of the Lyophilised Antitoxin:

Remove the ip off on the seal over the diaphragms of the vials of antivenin. Sterilize the rubber diaphragm with alcohol. Withdraw the diluent in a 10 mL sterile syringe. Insert the needle through the stopper of the vial containing antitoxin and point the diluent jet to the center of lyophilised pellet to be dissolved and in order to prevent oating. Swirl the vial gently for one to ve minutes and do not shake to avoid foaming.

Adverse Effects:

Immediate systemic reactions (anaphylaxis or allergy) may occur with horse serum. It may include ushing, itching, urticaria, cough, dyspnea, cyanosis, vomiting, hypotension, edema of the face, tongue, and throat and collapse. Cardiac arrest and death are very rare. Serum sickness may develop after 7-10 days and is manifested by fever, urticaria, lymphadenopathy, arthralgia and muscle pain. Occasional meningism or peripheral neuritis may occur.

Contraindications:

In case of severe envenomation threatening life or limb there is no contraindication for a history of allergy however, careful evaluation and expert management is required.

Before giving any horse serum, history of allergy or previous exposure to horse serum should be reviewed.

As recommended by the WHO, anti-shock measures including: Epinephrine 1:1000, corticosteroids, airway, oxygen, calcium salts and antihistamines should be readily available prior to administration of the antitoxin. If any systemic reaction occurs, serum administration should be discontinued immediately and appropriate antishock measures must be initiated.

Constant attendance and monitoring of vital signs, any untoward reaction is mandatory during antitoxin administration for at least 2 hours. The type of electrolyte solution used for dilution and the rate of intravenous delivery of the antitoxin must take into consideration- the age, weight, cardiac status of the patient, severity of envenomation and interval between the bite and initiation of therapy. Safety of the product during pregnancy and lactation has not been established; therefore the risk should be outweighed against the benet.

 

Therapy with beta adrenergic blockers has been associated with an increased severity of acute anaphylaxis. The antitoxin should not be used if turbid, expired or showing precipitation.

Shelf Life:

Four years from the date of manufacturing.

Store the freeze dried vial in cool and dark place (Protect from light) and avoid exposure to excessive heat. Reconstituted liquid should neither be stored for long nor be allowed to freeze.

Snake Venom Antitoxin is supplied as freeze dried powder in glass vials along with 10mL vial of Sterilised Water for Injections B.P.

Left over antitoxin and used empty vials should

Snake Venom Antiserum for Central Africa

Description

Polyvalent Snake Venom Antiserum (Central Africa) is prepared from hyper-immunised equines against the venoms of the corresponding venomous snakes, namely:

  • Gaboon Viper (Bitisgabonica rhinoceros):    0.60 mg
  • Russell’s Viper (Vipera russelli):                     0.60 mg
  • Saw-scaled Viper (Echis carinatus):                0.45 mg

Plasma obtained from the hyper-immunized equines is enzyme refined, purified and concentrated. Each mL of the Snake Venom Antiserum (after reconstitution to 10 mL for lyophilised form) neutralizes not less than the following quantities of venoms when tested in mice:

  • Gaboon Viper 0.60 mg
  • Russell’s Viper 0.60 mg
  • Saw scaled Viper 0.45 mg

Snake envenomation is serious and could be life threatening.

The consequences of the action of snake venoms vary considerably based on the group to which the particular venom belongs. This, in turn depends upon the composition of the venom. In envenomation by viperid and crotalid snakes, venom (Cytotoxic) breaks down tissues destroying the red blood cells, e.g. Gaboon viper, Russell’s viper and Saw scaled viper.

In cases of viper envenomation (Gaboon viper, Russell’s viper and Saw scaled viper) the venom is characterized by a low content of neurotoxins, but large quantities of cytotoxins and these being proteins of high molecular weight, diffuse slowly within the tissues, hence they initially cause severe symptoms of poisoning in the region of the bite. Consequently, local symptoms are prominent and severe. There is great and persistent pain and intensive swelling at the bite site. The venom of the viper contains several enzymes which may possibly act synergistically to produce shock, spontaneous hemorrhages in the organs and tissues, acute necrosis and death. There is constant and incessant oozing of blood from the bite site. Sloughing too occurs permitting other infections.

The venom has a toxic effect on many different types of cells causing destruction of cell membranes. The constitutional symptoms are, therefore, characterized by hemorrhages, both external and internal. Hemorrhages in the abdomen are responsible for pain, tenderness and vomiting. Death is due to heart failure, but there is no paralysis.

TREATMENT OF SNAKE BITE

FIRST AID

  1. Keep the patient calm. Let the patient lie down to ensure that the bitten part is at rest with minimal activity in a well-ventilated quiet place.
  2. Clean the bitten part by washing with sufficient water with care without disfiguring or defacing bite mark. Apply a broad and firm antiseptic dressing/bandage.
  3. Assure the victim and do not let him panic. Panic may enhance the circulation of venom in the body.
  1. Immediate neutralisation of the circulating venom is of utmost importance.
  2. For immediate effect, the Snake Venom Antiserum should be injected intravenously as soon as possible after the bite. As a first dose, at least 20 mL of the reconstituted serum should be injected intravenously slowly (1 mL per min.).
  3. The second dose should be repeated two hours after the first dose or even earlier, if the symptoms persist. If the symptoms, which vary with different snake venoms, indicate persistence of venom action, further doses should be repeated after every six hours until the symptoms disappear completely.
  4. At present, there is no simple method to measure the amount of circulating venom in the body, therefore the antivenin dose cannot be accurately recommended. It has been found that the clotting time returns to normal about two hours after the neutralisation of venom, therefore repeated testing of clotting time after the antivenom therapy is necessary. Close monitoring of the patient’s condition with urine output, blood pressure, pulse, respiration and urea and electrolyte estimations must be done. Local pain and necrosis at the site of bite may need attention, but is usually not very serious except in special circumstances such as a bite on the digit which can become gangrenous.
  5. First Aid treatment should never be relaxed even when the serum is administered. Intravenous injection of Snake Venom Antiserum in equine serum sensitive subjects can produce very severe serum reactions and even acute anaphylaxis. Further care should be taken to prevent these reactions.
  1. In case of Gaboon, Russell’s and Saw-scaled viper envenomation, sedatives such as small doses of barbiturate and/or analgesics (e.g. aspirin) may be given to relieve nervousness and pain.
  1. In case of syncope / shock, strychnine, pituitrin or other general stimulants like coramine may be used. The use of corticosteroids would help minimise serum reaction and other minor allergic reactions.
  1. Treatment with antibiotics may also be given to combat local sepsis. In severely envenomated cases, infusion of a large amount of physiological saline or transfusion of blood or plasma may not only bring substantial relief but may be life-saving in borderline cases.
  1. Cases of respiratory paralysis should be treated by tracheostomy and artificial respiration.
  1. Draw 10 mL of sterilised water for injections in a sterile syringe.
  1. Transfer the sterile water from the syringe to the vial and shake well till the contents dissolve.
  1. Let the vial stand for one minute for the serum to clear. The reconstituted serum will become crystal-clear and ready for injection. Froth if any, should be left in the vial.
  1. For the second and subsequent injections, you will have more time to dissolve the lyophilised serum. For these, add 10 mL sterilised water for injections to the serum vial and rotate it between the palms of your hands until the serum is fully dissolved and let the vial stand for serum to clear.

Store the freeze-dried vial in a cool, dark place, protected from light and avoid exposure to excessive heat. Reconstituted liquid should neither be stored for long nor be allowed to freeze.
10 mL liquid vials should be stored between 20C & 8OC.DO NOT FREEZE.

PREVENTION OF SERUM REACTION

Before injection of Snake Venom Antiserum it is necessary to enquire from the patient:

  1. Whether he has received any other antisera injection (eg. tetanus antitoxin or diphtheria antitoxin) before.
  1. Whether there is personal or familial history of allergy, i.e. asthma, eczema or drug allergy.

The sensitivity of the patient to Snake Venom Antiserum is tested by injecting subcutaneously 0.1 mL of this 1:10 diluted serum. The patient should be observed for 30 minutes for local and general reactions. If the test dose shows either local reaction such as flare or general anaphylactic reaction such as pallor, sweating, nausea, vomiting, urticaria, and fall of blood pressure, these should be countered immediately by intramuscular injection of 1 mL of 1:1000 adrenaline and with corticosteroids which should be always kept handy. A negative test is not an absolute guarantee for the absence of immediate allergic type reaction.

In allergic or sensitive patients, it is better to inject the Snake Venom Anti serum under cover of antihistamine such as antistaine (100 mg.) and hydrocortisone (100 mg.) intramuscularly 15 to 30 minutes before the administration of Snake Venom Antiserum.

The administration of adrenaline and hydrocortisone may be repeated if necessary.

When symptoms of snakebite are severe it may not be advisable to wait for 30 minutes to observe reactions to test-dose of serum. In such cases it may be better to inject 1 mL of 1:1000 adrenaline intramuscularly at the same time as the serum in order to lessen the risk of anaphylaxis. Half dose of adrenaline may be repeated 15 minutes later if necessary.

Snake Venom Antiserum (Central Africa) is supplied as freeze-dried powder in glass vials along with 10mL sterilized water for injections. The Snake Venom Antiserum is also supplied as 10 ml liquid in glass vials

Snake Venom Antiserum Echis Ocellatus monovalent for Africa

Snake Venom Antiserum Echis Ocellatus
(10 mL-Liquid/Lyophilised, Polyvalent,Enzyme Rened, Equine immunoglobulins)

Snake Venom Antiserum Echis is a sterile preparation containing equine immunoglobulin fragments F (ab’) 2. Freeze dried powder when reconstituted with 10mL of Sterilised Water for Injections B.P. supplied along with the vial.

Each lmL has capacity of specically neutralizing 40 LD50 of Echis ocellatus venom.

The antitoxic equine immunoglobulin and their derivatives are obtained from the serum of healthy equines immunized against venom of the above species of snake.

Reconstitution of Lyophilised Antiserum

The antivenom is supplied in liquid as well as freeze dried form. The freeze dried powder is reconstituted with 10 mL of Sterilised Water for Injections B.P. supplied with this pack. The whole content of freeze dried powder dissolves into a clear colourless or pale yellow liquid.

Administration and Dosage

Reconstituted antivenin is administered as soon possible if clear-cut signs/symptoms of envenomation are evident. It can be administered in two ways:

  1. Intravenous injections: Reconstituted antivenin is administered by slow intravenous injection (1-2 mL/minute).
  1. Infusion: Reconstituted antivenin is diluted in isotonic saline or glucose solution, 5-10 mL/Kg body weight.

At present there is no simple method to measure the amount of circulating venom in the body, therefore the antivenom dose cannot be accurately recommended. The dose also depends on severity of envenomation. In consideration to the requirement of venom neutralization fast, two vials are usually injected directly by I.V. route slowly .i.e. 1-2 mL/minute (taking care of sensitivity reaction). Two more vials are given after half an hour to one hour, if the symptoms of envenomation persist. This way patient should be given doses (further dose can be given with Intravenous uid) till the envenomation symptoms subside. The patient should be closely monitored for 2 hours. Local administration of antivenin in or around the bite site is ineffective, painful, and may raise intra compartmental pressure, particularly in the digits. Hence it is not recommended.

Snakebite Manifestations

In case of Echis ocellatus, paralytic manifestations are uncommon (though they have occasionally been reported with Russell’s viper).The usual manifestations comprise persistent pain and swelling of the bitten limb with oozing of blood from the bitesite.There may be blister formation and necrosis. This is followed by generalized vascular injury with severe external and internal haemorrhage.Vomiting may occur. Death usually results from cardiovascular shock or renal failure.

Anaphylaxis is life-threatening, but if the correct protocol is followed, it can be effectively treated and dealt with.

Anaphylaxis can be of rapid onset, and can deteriorate into a life- threatening emergency very quickly. The patient should be monitored closely, and at the rst sign of any of the following, antivenin should be discontinued, and 0.5 mg of 1:1000 adrenaline must be administered intramuscularly: urticaria, itching, fever, chills or rigor, nausea, vomiting, diarrhea, abdominal cramps, tachycardia, hypotension, bronchospasm, and angioedema. Children must be given 0.01 mg/Kg body weight of adrenaline I.M.

In addition, to provide longer term protection against anaphylactoid reaction, 100 mg of hydrocortisone and 10 mg of HI antihistamine can be given I.V. The dose for children is 0.2 mg/Kg of antihistamine I.V. and 2 mg/Kg of hydrocortisone I.V. If after 10 to 15 minutes, the patient’s condition has not improved, or if the condition is worsening, a second dose of 0.5 mg of adrenaline 1:1000

I.M. may be given. In the vast majority of cases, no more doses will be required. If there is hypotension or haemodynamic instability. I.V. uids should be given. Once the patient has recovered, the antivenin can be restarted slowly for 10-15 minutes keeping the patient under close observation. Then the normal drip rate can be resumed.

Serum sickness reactions sometimes occur. But these usually take a few days to a week, and can be easily treated with oral antihistamines and corticosteroids (for e.g., prednisolone-adults 5 mg 6 hourly; child 0.7 mg/Kg/day).

Snake bite can cause moderate to severe pain in at the bite site. This normally responds well to paracetamol. Aspirin and nonsteroidal anti-inammatory drugs (NSAIDs) should not be administered, as they can exacerbate bleeding. Mild opiates (such as tramadol 50 mg) can be administered, for severe pain.

Store the freeze dried preparation in a cool and dark place and avoid exposure to excessive heat. Reconstituted liquid should not be stored for long nor should be allowed to freeze. 10 mL liquid vials should be stored at 2°C to 8°C.DO NOT FREEZE. Protect from light. Keep out of reach of children.

Snake venom antiserum Echis as supplied is freeze dried powder in glass vials. Sterilised Water for Injections B.P. is supplied in 10 mL vials.

The antivenom is also supplied as 10 mL liquid in glass vials.

Left over antivenin and used empty vials should be discarded as biomedical waste.

Snake Venom Antiserum Naja kouthia monovalent for South East Asia

Cobra Antivenin is a sterile preparation containing equine immunoglobulin fragments F(ab’)2. Freeze dried powder when reconstituted to 10mL of Sterilized Water for Injections B.P. supplied along with the vial, each 1mL has capacity of specically neutralizing the venom of the following species of Snake.

Naja kaouthia –  0.600 mg

The antitoxic equine immunoglobulin and their derivatives are obtained from the serum of healthy equines hyperimmunized against Monocle Cobra venom.

The freeze dried powder is reconstituted with 10mL of Sterilized Water for Injections B.P. supplied with this pack. The whole content of freeze dried powder dissolves in to a clear, colorless or pale yellow liquid.

Reconstituted antivenin is administered as soon possible if clear-cut signs/symptoms of envenomation are evident. It can be administered in two ways:

  1. Intravenous injections: Reconstituted antivenin is administered by slow intravenous injection (1-2 mL/minute).
  1. Infusion: Reconstituted antivenin is diluted in isotonic saline or glucose solution, 5-10 mL/Kg body weight.

At present there is no simple method to measure the amount of circulating venom in the body, therefore the antivenom dose cannot be accurately recommended. The dose also depends on the type of snake bite and severity of envenomation. In consideration to the requirement of venom neutralization fast, two vials are usually injected directly by I.V. route slowly .i.e.1-2 mL/minute (taking care of sensitivity reaction). Two more vials are given after half an hour to one hour, if the symptoms of envenomation persists. This way patient should be given doses (further dose can be given with Intravenous uid) till the envenomation symptoms subside.

The patient should be closely monitored for 2 hours. Local administration of antivenin in or around the bite site is ineffective, painful, and may raise the intra compartmental pressure, particularly in the digits. Hence it is not recommended.

In Cobra bite, there is creeping paralysis of muscles of eyelids, staggering gait, difculty in speaking, blurred vision and drooping of head, accompanied by nausea and vomiting. These symptoms are due to the predominance of neurotoxins. Death may result due to respiratory failure

Anaphylaxis is life-threatening, but if the correct protocol is followed, it can be effectively treated and dealt with. Anaphylaxis can be of rapid onset, and can deteriorate into a life-threatening emergency very quickly. The patient should be monitored closely, and at the rst sign of any of the following, antivenin should be discontinued, and 0.5 mg of 1:1000 adrenaline must be administered intramuscularly: urticaria, itching, fever, chills or nrigor, nausea, vomiting, diarrhea, abdominal cramps, tachycardia, hypotension, bronchospasm, and angioedema. Children must be given 0.01 mg/Kg of body weight adrenaline I.M.

In addition, to provide longer term protection against anaphylactoid reaction, 100 mg of hydrocortisone and 10 mg of H1 antihistamine can be given I.V. The dose for children is 0.2 mg/Kg of antihistamine I.V. and 2 mg/Kg of hydrocortisone I.V. If after 10 to 15 minutes, the patient’s condition has not improved, or if the condition is worsening, a second dose of 0.5 mg of adrenaline 1:1000 I.M. may be given. In the vast majority of cases, no more doses will be required. If there is hypotension or haemodynamic instability, I.V. uids should be given. Once the patient has recovered, the antivenin can be restarted slowly for 10-15 minutes keeping the patient under close observation. Then the normal drip rate can be resumed. Serum sickness reactions sometimes occur. But these usually take a few days to a week, and can be easily treated with oral antihistamines and corticosteroids (for e.g., prednisolone-adults 5 mg 6 hourly; child 0.7 mg/Kg/day).

Snake bite can cause moderate to severe pain in at the bite site. This normally responds well to paracetamol. Aspirin and non-steroidal anti-inammatory drugs (NSAIDs) should not be administered, as they can exacerbate bleeding. Mild opiates (such as tramadol 50 mg) can be administered, as they can exacerbate bleeding. Mild opiates (Such as tramadol 50 mg) can be administered for severe pain. Neostigmine is an anticholinesterase drug, which prolongs the action of acetylcholine, there by reversing respiratory failure and neurotoxic symptoms. It is particularly effective in post-synaptic neurotoxins such as those of the Cobra.

Recommended dose: 0.5mg intramuscularly, half hourly, together with 0.6mg of atropine I.V. over an 8 hour period by continuous infusion. If there is no improvement in symptoms after one hour, neostigmine therapy should be stopped. Renal failure may require dialysis therapy.

Store the freeze dried preparation in a cool, dark place and avoid exposure to excessive heat. Reconstituted liquid should not be stored for long.

Cobra Antivenin is supplied as freeze dried powder in glass vials. Sterilised Water for Injections B.P. is supplied in 10mL vials.

Left over antivenin and used empty vials should be discarded as biomedical waste.

Snake Venom Antiserum Daboia ruselli monovalent for South East Asia

Russell’s Viper Antivenin is a sterile preparation containing equine immunoglobulin fragments F(ab’)2. Freeze dried powder when reconstituted to 10mL of Sterilized Water for Injections B.P. supplied along with the vial, each 1mL has capacity of specically neutralizing the venom of the following species of Snake.

  • Daboia ruselii siamensis  –  0.600 mg

The antitoxic equine immunoglobulin and their derivatives are obtained from the serum of healthy equines hyperimmunized against Eastern Russell’s Viper venom.

The freeze dried powder is reconstituted with 10mL of Sterilized Water for Injections B.P. supplied with this pack. The whole content of freeze dried powder dissolves in to a clear, colorless or pale yellow liquid.

Reconstituted antivenin is administered as soon possible if clear-cut signs/symptoms of envenomation are evident. It can be administered in two ways:

  1. Intravenous injections: Reconstituted antivenin is administered by slow intravenous injection (1-2 mL/minute).
  1. Infusion: Reconstituted antivenin is diluted in isotonic saline or glucose solution, 5-10 mL/Kg body weight.

At present there is no simple method to measure the amount of circulating venom in the body, therefore the antivenom dose cannot be accurately recommended. The dose also depends on the type of snake bite and severity of envenomation. In consideration to the requirement of venom neutralization fast, two vials are usually injected directly by I.V. route slowly .i.e.1-2 mL/minute (taking care of sensitivity reaction). Two more vials are given after half an hour to one hour, if the symptoms of envenomation persists. This way patient should be given doses (further dose can be given with Intravenous uid) till the envenomation symptoms subside.

The patient should be closely monitored for 2 hours. Local administration of antivenin in or around the bite site is ineffective, painful, and may raise the intra compartmental pressure, particularly in the digits. Hence it is not recommended.

Snakebite Manifestations

In case of Russell’s Viper paralytic manifestations are uncommon (though they have occasionally been reported. The usual manifestations comprise persistent pain and swelling of the bitten limb with oozing of blood from the bite site. There may be blister formation and necrosis. This is followed by generalized vascular injury with severe external and internal hemorrhage. Vomiting may occur. Death usually results from cardiovascular shock or renal failure.

Antivenin Reactions

Anaphylaxis is life-threatening, but if the correct protocol is followed, it can be effectively treated and dealt with. Anaphylaxis can be of rapid onset, and can deteriorate into a life-threatening emergency very quickly. The patient should be monitored closely, and at the rst sign of any of the following, antivenin should be discontinued, and 0.5 mg of 1:1000 adrenaline must be administered intramuscularly: urticaria, itching, fever, chills or

rigor, nausea, vomiting, diarrhea, abdominal cramps, tachycardia, hypotension, bronchospasm, and angioedema. Children must be given 0.01 mg/Kg of body weight adrenaline I.M. In addition, to provide longer term protection against anaphylactoid reaction, 100 mg of hydrocortisone and 10 mg of H1 antihistamine can be given I.V. The dose for children is 0.2 mg/Kg of antihistamine I.V. and 2 mg/Kg of hydrocortisone I.V. If after 10 to 15 minutes, the patient’s condition has not improved, or if the condition is worsening, a second dose of 0.5 mg of adrenaline 1:1000 I.M. may be given. In the vast majority of cases, no more doses will be required. If there is hypotension or haemodynamic instability. I.V. uids should be given. Once the patient has recovered, the antivenin can be restarted slowly for 10-15 minutes keeping the patient under close observation. Then the normal drip rate can be resumed. Serum sickness reactions sometimes occur. But these usually take a few days to a week, and can be easily treated with oral antihistamines and corticosteroids (for e.g., prednisolone-adults 5 mg 6 hourly; child 0.7 mg/Kg/day).

Snake bite can cause moderate to severe pain in at the bite site. This normally responds well to paracetamol. Aspirin and non-steroidal anti-inammatory drugs (NSAIDs) should not be administered, as they can exacerbate bleeding. Mild opiates (such as tramadol 50 mg) can be administered, as they can exacerbate bleeding. Mild opiates (Such as tramadol 50 mg) can be administered for severe pain. Neostigmine is an anticholinesterase drug, which prolongs the action of acetylcholine, there by reversing respiratory failure and neurotoxic symptoms. It is particularly effective in post-synaptic neurotoxins such as those of the Cobra.

Recommended dose: 0.5mg intramuscularly, half hourly, together with 0.6mg of atropine I.V. over an 8 hour period by continuous infusion. If there is no improvement in symptoms after one hour, neostigmine therapy should be stopped. Renal failure may require dialysis therapy.

Recommended dose

0.5mg intramuscularly, half hourly, together with 0.6mg of atropine I.V. over an 8 hour period by continuous infusion. If there is no improvement in symptoms after one hour, neostigmine therapy should be stopped. Renal failure may require dialysis therapy.

Store the freeze dried preparation in a cool, dark place and avoid exposure to excessive heat. Reconstituted liquid should not be stored for long nor should be allowed to freeze.

Russell’s Viper Antivenin is supplied as freeze dried powder in glass vials. Sterilised Water for Injections B.P. is supplied in 10mL vials.

Left over antivenin and used empty vials should be discarded as biomedical waste.