Anavip (antivenin,Crotalidae (equine))

Injection Vial (EA)

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Last reviewed · Source: First Databank (FDB) drug data

Overview

Crotalidae immune F(ab')2 (equine) is an antivenin (antivenom) preparation containing equine immunoglobulin G (IgG) F(ab')2 fragments capable of binding and neutralizing venom toxins of North American rattlesnakes (pit vipers).

Crotalidae immune F(ab')2 (equine) is a polyvalent antivenin (antivenom) preparation of venom-specific F(ab')2 fragments of equine immunoglobulin G (IgG) that bind and neutralize venom toxins of Crotalinae (rattlesnakes; pit vipers; genera Crotalus and Sistrurus) native to North America. The antivenin is prepared from the plasma of horses immunized with the venom of Bothrops asper and Crotalus durissus. The antivenin is obtained by pepsin digestion of the equine plasma to remove the Fc portion of the equine IgG, followed by fractionation and purification to isolate the venom-specific F(ab')2 fragments.

Crotalidae immune F(ab')2 (equine) commercially available in the US is a sterile, lyophilized preparation that contains not less than 85% F(ab')2, not more than 7% F(ab'), and less than 5% intact immunoglobulin. The antivenin is stabilized with sodium chloride, sucrose, and glycine, and may contain trace amounts of pepsin, cresol, borates, and sulfates from the manufacturing process. Several steps in the manufacturing process (pepsin digestion, ammonium sulfate precipitation/heat treatment, nanofiltration) reduce the risk of transmission of viruses.

Crotalidae immune F(ab')2 (equine) is standardized by its ability to neutralize B. asper and C. durissus venom in mice (mouse LD50 neutralizing units). Each commercially available vial of the antivenin will neutralize at least 780 mouse LD50 units of B. asper venom and 790 mouse LD50 units of C. durissus venom.

Following IV administration, the F(ab')2 fragments in Crotalidae immune F(ab')2 (equine) bind to venom components, facilitating redistribution of the venom away from target tissues and elimination from the body. In healthy (nonenvenomed) adults, Crotalidae immune F(ab')2 (equine) has a mean elimination half-life of approximately 5.5 days following a single IV dose.

Generic name: antivenin,Crotalidae (equine)
Therapeutic class: Biologicals

Reference product & biosimilars

No reference, biosimilar or interchangeable associated with this drug.

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Indications

The following indications are listed for Anavip:

  • Envenomation By Pit Viper Snake (Crotalidae)

Also known as: Pit Viper Snake Envenomization, Poisoned Bite Of Pit Viper Snake, Poisoning Due To Bite Of Crotalidae, Poisoning Due To Venom Of Crotalidae, Poisoning Due To Venom Of Pit Viper Snake, Toxic Effect Of Venom From A Pit Viper Snake.

Dosing

Dosage of Crotalidae immune F(ab')2 (equine) is expressed in terms of the number of vials of the antivenin.

For the management of envenomation following snakebites involving North American rattlesnakes, the initial dose (number of vials) of Crotalidae immune F(ab')2 (equine), need for additional initial doses to achieve envenomation control, and number of subsequent doses required for maintenance to sustain envenomation control should be based on individual patient response. Age-related dosage adjustments are not indicated. (See Pediatric Use under Warnings/Precautions: Specific Populations, in Cautions.)

The recommended initial dose of Crotalidae immune F(ab')2 (equine) in adults and children is 10 vials. Patients should be monitored during and for at least 1 hour after completion of the initial infusion for allergic reactions and to determine if initial control of envenomation has been achieved (i.e., local manifestations not progressing, systemic symptoms resolved, and coagulation abnormalities normalized or trending towards normalization).

If initial control of envenomation is not achieved after the initial dose, additional 10-vial doses may be administered every 60 minutes as needed.

After initial control of envenomation has been established, patients should be monitored closely for at least 18 hours in a healthcare setting for reoccurrence of coagulation abnormalities. If coagulation abnormalities reoccur, additional 4-vial doses of Crotalidae immune F(ab')2 (equine) are recommended as needed.

The maximum dose of Crotalidae immune F(ab')2 (equine) that can be administered safely is not known.

Drug interactions

No formal drug interaction studies have been performed using Crotalidae immune F(ab')2 (equine).

Contraindications

The manufacturer states that there are no contraindications to use of Crotalidae immune F(ab')2 (equine).

Adverse reactions

Adverse effects reported in 2% or more of patients receiving Crotalidae immune F(ab')2 (equine) include pruritus, nausea, rash, arthralgia, myalgia, peripheral edema, headache, extremity pain, vomiting, pyrexia, blister, erythema, chills, anxiety, insomnia, and dehydration.

Precautions

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ICD codes

CodeTypeDescription
Envenomation by pit viper snake (crotalidae)
T63.061AICD10CMToxic effect of venom of other north and south american snake, accidental (unintentional), initial encounter
T63.062AICD10CMToxic effect of venom of other north and south american snake, intentional self-harm, initial encounter
T63.063AICD10CMToxic effect of venom of other north and south american snake, assault, initial encounter
T63.064AICD10CMToxic effect of venom of other north and south american snake, undetermined, initial encounter

ICD code information from First Databank (FDB).

Formulary status

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Last reviewed · Source: First Databank (FDB) drug data