antivenin, eastern & Texas coral snakes (Discontinued)

Brand and Other Names:Antivenin (Micrurus fulvius)
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

lyophilized powder for injection

  • 10mL/vial
more...

Envenomations

SKIN TEST (ID) FIRST (0.02 mL injected intradermally of a 1:10 dilution of Normal Horse Serum or Antivenin & observe for 20 minutes; if wheal/flare response occurs, treat in ICU setting)

Initial: 3-5 vials by slow IV infusion

Administer inital 1-2 mL over 3-5 minutes either slow IVP or infusion

10+ vials may be needed

If skin test mildly positive or unsure

  • Prepare 1:10 and 1:100 dilutions, and administer as follows if no reaction at each step
  • 1) 0.1, 0.2, and 0.5 mL of 1:100 dilution SC q15min, THEN
  • 2) Same amount with 1:10 dilution, THEN
  • 3) Same amount with undiluted, THEN
  • 4) Switch to IM and continue doubling dose q15min or IV infusion

Additional Information

Equine-derived antibodies against venom from Eastern & Texas coral snakes; not active against Western Arizona or Sonoran coral snakes

Arizona poison control center 520-626-6016 (Tucson); Emergency 1-800-222-1222

Treat allergic reactions with corticosteroids (ie, Solu-Medrol 125 mg IVP), antihistamines, and epinephrine; may help to slow IV infusion or further dilute antivenom; pretreat if positive skin test

Empirical recommendation: pretreat with diphenhydramine 25 mg IV and start epinephrine (1:1,000) 1 mg in 250 mL NS drip at low rate (50 mL/hr) prior to giving antivenom

Other Indications & Uses

Micrurus fulvius fulvius (Eastern and Texas coral snake) envenomations

NOT active against Western Arizona or Sonoran coral snake venom

Dosage Forms & Strengths

lyophilized powder for injection

  • 10mL/vial
more...

Envenomations

SKIN TEST (ID) FIRST (0.02 mL injected intradermally of a 1:10 dilution of Normal Horse Serum or Antivenin & observe for 20 minutes; if wheal/flare response occurs, treat in ICU setting)

Initial: 3-5 vials by slow IV infusion

Administer inital 1-2 mL over 3-5 minutes either slow IVP or infusion

10+ vials may be needed

If skin test mildly positive or unsure

  • Prepare 1:10 and 1:100 dilutions, and administer as follows if no reaction at each step
  • 1) 0.1, 0.2, and 0.5 mL of 1:100 dilution SC q15min, THEN
  • 2) Same amount with 1:10 dilution, THEN
  • 3) Same amount with undiluted, THEN
  • 4) Switch to IM and continue doubling dose q15min or IV infusion
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Adverse Effects

Frequency Not Defined

Anaphylaxis (within 30 min)

Cyanosis

Edema of face, tongue, & throat

Flushing

Itching

Urticaria

Vomiting

Wheezing

Arthus reaction

Serum sickness (if >8 vials used)(usually 5-24 days after admin)

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Warnings

Contraindications

NONE for life-threatening situation

Prophylactic use

Cautions

Anaphylaxis to horse serum

Absence of early anaphylaxis no guarantee of later reactions or serum sickness

Do NOT give concomitant morphine or strong sedatives

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Administration

IV Preparation

Reconstitute by adding 10 mL of supplied diluent (SWI) into drug vial

Make sure diluent falls directly onto pellet - do NOT pour on wall, pellet will float making complete reconstitution difficult

Swirl (no shaking/vortexing to avoid foaming) to dissolve; complete reconstitution takes ~30 min

IV Administration

Start IV infusion with 250-500 mL NS

Administer 3-5 vials (30-50 mL) by slow IVP directly into IV tubing, or by adding to infusion bottle

In either case, inject first 1-2 mL over a 3-5-min

If no S/S of anaphylaxis continue to administer

If administered as admixture, infuse at maximum safe rate for IV fluids (eg, adults over 250-500 mL 30 min; small children initial 100 mL rapidly, then decrease infusion rate to 4 mL/min or less

Storage:

Refrigerate unopened vials, do not freeze

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