Dosing and uses of Antivenin (Micrurus fulvius) (antivenin, eastern and Texas coral snakes)
Adult dosage forms and strengths
lyophilized powder for injection
- 10mL/vial
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
Pediatric dosage forms and strengths
lyophilized powder for injection
- 10mL/vial
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
Antivenin (Micrurus fulvius) (antivenin, eastern and Texas coral snakes) adverse (side) 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)
Warnings
Contraindications
NONE for life-threatening situation
Prophylactic use
Cautions
Anaphylaxis to horse serum
Absence of early anaphylaxis no guarantee of later rxns or serum sickness
Do NOT give concomitant morphine or strong sedatives
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
