Antivenom

 ( Toxicology Treatments ) 

In the US, approved antivenom, including for pit viper (rattlesnake, copperhead and water moccasin) snakebite, is based on a purified product made in sheep known as CroFab. Link to PDF for full prescribing information, retrieved 11/11/12 It was approved by the FDA in October 2000. U.S. coral snake antivenom ceased production, and remaining stocks of in-date antivenom for coral snakebite expired in fall 2009, leaving the U.S. without a coral snake antivenom. However, as of July 2021, Pfizer has indicated that antivenom is available. Efforts are being made to obtain approval for a coral snake antivenom produced in Mexico which would work against U.S. coral snakebite, but such approval remains speculative.

As an alternative when conventional antivenom is not available, hospitals sometimes use an intravenous version of the antiparalytic drug neostigmine to delay the effects of neurotoxic envenomation through snakebite.Franklin, Deborah, " Potential Treatment For Snakebites Leads To A Paralyzing Test Shortages of coral snake antivenom were previously reported,242526 but one source states that production has resumed27 and, as of July 2021, Pfizer indicates that antivenom is available.28 ", NPR.org, July 31, 2013. Some promising research results have also been reported for administering the drug nasally as a "universal antivenom" for neurotoxic snakebite treatment." Universal antidote for snakebite: Experimental trial represents promising step ", California Academy of Sciences via Science Daily, May 28, 2014.

A monovalent antivenom is specific for one toxin or species, while a polyvalent one is effective against multiple toxins or species.

The majority of antivenoms (including all ) are administered intravenously; however, stonefish and redback spider antivenoms are given intramuscularly. The intramuscular route has been questioned in some situations as not uniformly effective.

Natural immunity of snakes to their own venom was observed at least as long ago as 1767, by Felice Fontana in his work Ricerche Fisiche sopra il Veleno della Vipera (Physical Research on the Venom of the Viper). Surgeon-Major Edward Nicholson wrote in the November 1870 Madras Medical Journal that he had witnessed a Burmese snake-catcher inoculating himself with cobra venom. However, the snake-catcher was unsure whether this was actually effective and therefore continued to treat his snakes with care. Nicholson, along with other Britons, began to consider that venom might provide its own cure. Although Scottish surgeon Patrick Russell had noted in the late 18th century that snakes were not affected by their own venom, it was not until the late 19th century that Joseph Fayrer, Laurence Waddell, and others began to consider venom-based remedies again. However, they and other naturalists working in India did not have the funding to fully develop their theories. In 1895 Sir Thomas Fraser, Professor of Medicine at the University of Edinburgh, picked up Fayrer and Waddell's research to produce a serum to act against cobra venom. His "antivenene" was effective in the laboratory, but failed to make an impact as the public were focused on contemporary Pasteurian discoveries.

In 1901, Vital Brazil, working at the Instituto Butantan in São Paulo, Brazil, developed the first monovalent and polyvalent antivenoms for Central and South American Crotalus and Bothrops genera, as well as for certain species of venomous , , and . In Mexico in 1905, Daniel Vergara Lope developed an antivenom against scorpion venom, by immunizing dogs. In Australia, the Commonwealth Serum Laboratories (CSL) began antivenom research in the 1920s. CSL has developed antivenoms for the redback spider, funnel-web spiders and all deadly Australian snakes. In the USA, the H.K. Mulford company began producing "Nearctic Crotalidae antivenin" in 1927, via a consortium called the Antivenin Institute of America.

Over time, a variety of improvements have been made in the specificity, potency, and purity of antivenom products, including "salting out" with ammonium sulphate or caprylic acid, enzymatic reduction of antibodies with papain or with pepsin, affinity purification, and a variety of other measures. Many equine facilities now use plasmapheresis to collect blood plasma instead of blood serum.

Antivenom undergoes successive price markups after manufacturing, by licencees, wholesalers and hospitals. When weighed against profitability (especially for sale in poorer regions), the result is that many snake antivenoms, world-wide, are very expensive. Availability, from region to region, also varies.

Internationally, antivenoms must conform to the standards of pharmacopoeia and the World Health Organization (WHO).

Antivenoms have been developed for the venoms associated with the following animals:

Historically, the term antivenin was predominant around the world, its first published use being in 1895. In 1981, the World Health Organization decided that the preferred terminology in the English language would be venom and antivenom rather than venin and antivenin or venen and antivenene.