protecting [12:<6 months of age, are at greatest risk of mercury toxicity. 18 19 20 Although it has been suggested that thimerosal added as a preservative or used during the manufacturing process of vaccines or plasma-derived products theoretically could have adverse effects in recipients, there is no conclusive evidence that low concentrations of thimerosal contained in vaccines cause harm in vaccine recipients. 27 28 29 32 34 35 36 37 38 39 Efforts to eliminate or reduce the thimerosal content in such products are recommended as a prudent measure to reduce mercury exposure in infants and children and part of an overall strategy to reduce mercury exposures from all sources, including food and drugs. 18 19 20 23 27 Specific Populations Pregnancy Category C. 1 Has been used in pregnant women without unusual adverse effects. 9 15 16 Lactation Not known whether distributed into milk. 1 Use with caution in nursing women. 1 Pediatric Use Safety and efficacy not specifically studied. 1 Has been used in children without unusual adverse effects. 1 2 11 Geriatric Use No evidence of different responses between geriatric adults and younger patients. 1 Because of increased risk of envenomation complications in geriatric adults, use antivenin in patients> 60 years of age whenever indicated. 1 Common Adverse Effects Sensitivity reactions, muscle cramps. 1 Interactions for Antivenin (Latrodectus mactans) (Equine) Data not available regarding drug interactions. 1 Antivenin (Latrodectus mactans) (Equine) Pharmacokinetics Absorption Data not available regarding pharmacokinetics after IM or IV administration. 1 Onset Symptomatic relief of envenomation may occur within 30 minutes following dose; 4 11 manifestations usually subside within 1 3 hours. 1 Stability Storage Parenteral Powder for Injection 2 8 C; do not freeze or expose to excessive heat. 1 3 Actions Antivenin (Latrodectus mactans) (equine) is a preparation of equine venom-neutralizing immunoglobulins capable of neutralizing venom toxins of black widow spiders ( L. mactans ). 1 Exact pharmacologic mechanism of action unknown. 1 Manufactured from serum of healthy horses immunized against venom of black widow spiders ( Latrodectus mactans ). 1 Standardized by ability to neutralize action of L. mactans venom given IV to mice (mouse LD 50 neutralizing units). 1 3 Each vial contains at least 6000 mouse LD 50 of antivenin. 1 3 Advice to Patients Importance of informing clinicians of prior exposure to preparations containing equine serum or history of any allergies. 1 Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. 1 Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses. 1 Importance of informing patients of other important precautionary information. 1 (See Cautions.) Preparations Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. Because of limited supplies, manufacturer ships the antivenin only for patients with symptomatic bites. 40 41 To obtain the antivenin for a patient with a confirmed symptomatic bite by a black widow spider, clinicians should call the Merck National Service Center call line at 800-672-6372. 40 41 FDA has extended the expiration date for packaged lot #H019984 of the antivenin until January 3, 2015 (based on stability data). 40 41 Packaged lot #H019984 contains a vial of antivenin lot #0672105, a vial of sterile water for injection diluent, and a vial of equine serum for sensitivity testing. 40 41 Antivenin lot #0672105 contained in the package has a new expiration date and may be used until January 3, 2015. 40 41 However, the expiration date for diluent lot #0671078 contained in the package has not been extended and this diluent should not be used to reconstitute the antivenin. 40 41 Antivenin (Latrodectus mactans) (Equine) Routes Dosage Forms Strengths Brand Names Manufacturer Parenteral For injection Containing at least 6000 antivenin units Antivenin (Latrodectus mactans) Black Widow Spider Antivenin Equine Merck AHFS DI Essentials. Copyright 2017, Selected Revisions February 18, 2015. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. References 1. Merck & Co, Inc. Antivenin (Latrodectus mactans) (Black Widow Spider Antivenin) Equine Origin prescribing information. Whitehouse Station, NJ; 2014 Feb. 2. O'Malley GF, Dart RC, Kuffner EF. Successful treatment of latrodectism with antivenin after 90 hours. N Engl J Med . 1999; 340:657. [PubMed 10049091] 3. The United States pharmacopeia, 25th rev, and The national formulary, 20th ed. Rockville, MD: The United States Pharmacopeial Convention, Inc; 2002:158. 4. Clark RF, Wethern-Kestner S, Vance MV et al. Clinical presentation and treatment of black widow spider envenomation: a review of 163 cases. Ann Emerg Med . 1992;21:782-7 5. Clark RF. The safety and efficacy of antivenin Latrodectus mactans. Clin Toxicol . 2001;39:125-7. 6. Erffmeyer JE. Serum sickness. Ann Allergy . 1986;56:105-9. 7. Utah Poison Control Center for Health Professionals. Black widow spider envenomation. 2002 Dec. From website. 9. Monte AA, Bucher-Bartelson B, Heard KJ. A US perspective of symptomatic Latrodectus spp. envenomation and treatment: a National Poison Data System review. Ann Pharmacother . 2011; 45:1491-8. [PubMed 22116992] 10. Isbister GK, Fan HW. Spider bite. Lancet . 2011; 378:2039-47. [PubMed 21762981] 11. Offerman SR, Daubert GP, Clark RF. The treatment of black widow spider envenomation with antivenin latrodectus mactans: a case series. Perm J . 2011; 15:76-81. [PubMed 22058673] 12. Nordt SP, Clark RF, Lee A et al. Examination of adverse events following black widow antivenom use in California. Clin Toxicol (Phila) . 2012; 50:70-3. [PubMed 22175789] 14. Murphy CM, Hong JJ, Beuhler MC. Anaphylaxis with Latrodectus antivenin resulting in cardiac arrest. J Med Toxicol . 2011; 7:317-21. [PubMed 22052335] 15. Handel CC, Izquierdo LA, Curet LB. Black widow spider (Latrodectus mactans) bite during pregnancy. West J Med . 1994; 160:261-2. [PubMed 8191768] 16. Sherman RP, Groll JM, Gonzalez DI et al. Black widow spider (Latrodectus mactans) envenomation in a term pregnancy. Curr Surg . 2000; 57:346-348. [PubMed 11024247] 18. Centers for Disease Control and Prevention. Recommendations regarding the use of vaccines that contain thimerosal as a preservative. MMWR Morb Mortal Wkly Rep . 1999; 48:996-8. [PubMed 10577494] 19. American Academy of Pediatrics Committee on Infectious Diseases and Committee on Environmental Health. Thimerosal in vaccines: an interim report to clinicians (RE9935). Pediatrics . 1999; 104:570-4. [PubMed 10469789] 20. Centers for Disease Control and Prevention. Thimerosal in vaccines: a joint statement of the American Academy of Pediatrics and the Public Health Service. MMWR . 1999; 48:563-5. [PubMed 10418806] 21. Aberer W. Vaccination despite thimerosal sensitivity. Contact Dermatitis . 1991; 24:6-10. [PubMed 2044374] 22. Food and Drug Administration (FDA). Mercury in plasma-derived products. From FDA website. Accessed 2012 Mar 12. 23. National Center for Immunization and Respiratory Diseases. General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep . 2011; 60:1-64. 25. Food and Drug Administration. Thimerosal in vaccines. From FDA website. Accessed 2008 Oct 27. 27. Food and Drug Administration. Thimerosal in vaccines. Frequently asked questions (FAQ). From FDA website. Accessed 2008 Oct 27. 28. Institute of Medicine. Immunization safety review: thimerosal-containing vaccines and neurodevelopmental disorder. Washington DC; National Academy Press; 2001. From IOM website. Accessed 2003 Jul 24. 29. Thompson WW, Price C, Goodson B et al. Early thimerosal exposure and neuropsychological outcomes at 7 to 10 years. N Engl J Med . 2007; 357:1281-92. [PubMed 17898097] 30. Pichichero ME, Gentile A, Giglio N et al. Mercury levels in newborns and infants after receipt of thimerosal-containing vaccines. Pediatrics . 2008; 121:e208-14. [PubMed 18245396] 31. Zheng W, Dreskin SC. Thimerosal in influenza vaccine: an immediate hypersensitivity reaction. Ann Allergy Asthma Immunol . 2007; 99:574-5. [PubMed 18219843] 32. Madsen KM, Lauritsen MB, Pedersen CB et al. Thimerosal and the occurrence of autism: negative ecological evidence from Danish population-based data. Pediatrics . 2003; 112:604-6. [PubMed 12949291] 33. Lee-Wong M, Resnick D, Chong K. A generalized reaction to thimerosal from an influenza vaccine. Ann Allergy Asthma Immunol . 2005; 94:90-4. [PubMed 15702823] 34. Parker S, Todd J, Schwartz B et al. Thimerosal-containing vaccines and autistic spectrum disorder: a critical review of published original data. Pediatrics . 2005; 115:200. [PubMed 15630018] 35. Schechter R, Grether JK. Continuing increases in autism reported to California's developmental services system: mercury in retrograde. Arch Gen Psychiatry . 2008; 65:19-24. [PubMed 18180424] 36. Andrews N, Miller E, Grant A et al. Thimerosal exposure in infants and developmental disorders: a retrospective cohort study in the United kingdom does not support a causal association. Pediatrics . 2004; 114:584-91. [PubMed 15342825] 37. Verstraeten T, Davis RL, DeStefano F et al. Safety of thimerosal-containing vaccines: a two-phased study of computerized health maintenance organization databases. Pediatrics . 2003; 112:1039-48. [PubMed 14595043] 38. Hviid A, Stellfeld M, Wohlfahrt J et al. Association between thimerosal-containing vaccine and autism. JAMA . 2003; 290:1763-6. [PubMed 14519711] 39. Institute of Medicine. Immunization safety review: vaccines and autism. Washington DC; National Academy Press; 2004. From IOM website. Accessed 2008 Oct 28. 40. Food and Drug Administration. Information for health care professionals: extension of expiration date for black widow spider antivenin packaged lot H019984 until January 3, 2015 and instructions for diluent use. Accessed 2014 Nov 10. 41. Perry ES. Dear Health Care Provider letter regarding important product supply information for antivenin (Lactrodectus mactans) (Equine Origin). Extension of expiration dating to January 3, 2015 packaged lot H019984. Merck; 2014 Jul 3. From FDA website. Accessed 2014 Nov 10. a. AHFS Drug Information 2012. McEvoy GK, ed. Antivenin (Latrodactus mactans) (Equine). Bethesda, MD: American Society of Health-System Pharmacists; 2012. Next Interactions Print this page Add to My Med List More about antivenin (black widow spider) Side Effects During Pregnancy Drug Interactions Support Group 0 Reviews Add your own review/rating Drug class: antitoxins and antivenins Consumer resources Antivenin Related treatment guides Venomous Spider Bite ]} FEATURED: CAR-T Cell Therapy Overview Mechanism of Action KTE-C19 Studies KTE-C19 Cancer Targets Adverse Events Manufacturing Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Drug Class Antitoxins and antivenins Related Drugs Venomous Spider Bite antivenin (black widow spider) , More... Antivenin (black widow spider) Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first!} } earlier than
and you may Antivenin (Latrodectus mactans) (Equine) find out
EmoticonEmoticon