picks [12:<12 years of age. There appears to be no clinical difference in efficacy between the IM and IV route of administration (Isbister 2008). Horse serum for sensitivity testing: Intradermal: Inject the horse serum test solution into (not under) the skin; evaluate after 10 minutes against a control test (intradermal injection of NS). Ophthalmic: Instill the horse serum test solution into the conjunctival sac; a positive reaction, if present, will generally occur within 10 minutes Antivenin for desensitization: SubQ: Administer the antivenin via SubQ injection. Allow 15 to 30 minutes between injections; proceed with the next dose only if a reaction has NOT occurred following the previous dose. If a reaction occurs, apply a tourniquet proximal to the injection site and administer epinephrine (1 mg/mL) SubQ or IV proximal to the tourniquet or into another extremity. Wait at least 30 minutes prior to continuing the desensitization procedure. If no reaction occurs after administration of 0.5 mL of antivenin (undiluted), then may consider administering dose at 15 minute intervals. Storage Refrigerate at 2 C to 8 C (36 F to 46 F). Do not freeze. Drug Interactions There are no known significant interactions. Adverse Reactions Frequency not defined. Dermatologic: Skin rash (rare; associated with hypersensitivity reaction) Hypersensitivity: Anaphylaxis, hypersensitivity reaction, serum sickness Neuromuscular & skeletal: Muscle cramps Warnings/Precautions Concerns related to adverse effects: Allergic reactions: May be less frequent than described in initial studies (Clark, 2001; Offerman, 2011). One retrospective study reviewed 163 cases of black widow spider envenomation; 58 patients received antivenin therapy and only 1 case of anaphylaxis occurred (Clark, 1992). The risk of reaction appears to be greatest with bolus administration of undiluted antivenin (Clark, 2001). Delayed serum sickness: Delayed serum sickness, albeit uncommon, may occur 1 to 2 weeks following administration, especially when large doses are used (Clark, 2001). Horse serum hypersensitivity: Carefully review allergies and history of exposure to products containing horse serum. History of atopic sensitivity to horses may increase the risk of immediate sensitivity reactions. Use with caution in patients with asthma, hay fever, or urticaria; fatal anaphylaxis has been reported in patients with a history of asthma. All patients require close monitoring in a setting where resuscitation can be performed. Special populations: Elderly patients: Due to an increased risk for complications of envenomation, the administration of antivenin may be the preferred initial therapy in patients> 60 years of age. Dosage form specific issues: Thimerosal: Some products may contain thimerosal. Other warnings/precautions: Desensitization: A desensitization protocol is available if sensitivity tests are mildly or questionably positive to reduce risk of immediate severe hypersensitivity reaction. According to the manufacturer, desensitization should be performed when antivenin administration would be lifesaving; however, the risk of anaphylaxis should be weighed against the risks associated with delayed antivenin administration (Rojnuckarin, 2009). Skin/conjunctival test: A skin or conjunctival test may be performed prior to use; however, the utility of skin and conjunctival tests to accurately identify patients at risk of early (anaphylactic) or late (serum sickness) hypersensitivity reactions to horse-derived antivenins has been questioned (WHO, 2005). Normal horse serum (1:10 dilution) is included for sensitivity testing. The absence of a skin or conjunctival hypersensitivity reaction does not exclude the possibility of anaphylaxis or hypersensitivity following antivenin administration. The false-negative rate for skin testing is 10% with similar agents. Conversely, hypersensitivity is not an absolute contraindication in a significantly envenomated patient. Monitoring Parameters Vital signs; hypersensitivity reactions; serum sickness reaction (for 2 to 3 weeks following administration); worsening of symptoms due to envenomation Pregnancy Risk Factor C Pregnancy Considerations Animal reproduction studies have not been conducted. Use during pregnancy (second and third trimester) has been described in case reports; all patients delivered healthy infants (Handel, 1994; Russell, 1979; Sherman, 2000). In general, medications used as antidotes should take into consideration the health and prognosis of the mother; antidotes should be administered to pregnant women if there is a clear indication for use and should not be withheld because of fears of teratogenicity (Bailey, 2003). Treatment of a pregnant patient with antivenom should be considered early in the course of an envenomation and in patients experiencing local, regional, or systemic effects refractory to opioids and/or benzodiazepines (Brown, 2013). Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Patient may experience muscle cramps (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients. Print this page ] Recently Approved Lonhala Magnair Lonhala Magnair (glycopyrrolate) is a long-acting muscarinic antagonist (LAMA) bronchodilator for... Ozempic Ozempic (semaglutide) is a glucagon-like peptide-1 (GLP-1) analog administered once-weekly for the... 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many manmade Antivenin (Latrodectus mactans) now and again
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