Pharmacology

1. 
   

   To produce the antivenom for North American coral snake bites, horses are hyperimmunized with venom from Micrurus fulvius, the eastern coral snake. The lyophilized protein preparation from pooled equine sera contains IgG antibodies to venom fractions as well as residual serum proteins. Administered intravenously, the antibodies distribute widely throughout the body, where they bind the target venom.

   
   
2. 
   

   Exotic antivenoms. Companies outside the United States produce a variety of antivenoms for exotic snakebites. Most of these products are used to treat snakebites by elapids because this family of snakes causes the most severe envenomations worldwide. The majority are still whole-antibody products derived from horses. A few are produced as Fab fragments, or the slightly larger Fab2 molecule (cleaved with pepsin instead of papain). In both of these cases, the Fc is removed from the solution. Many foreign antivenom products are polyvalent, a mixture of antivenoms for several species.

Indications

1. 
   

   Envenomation by the eastern coral snake (M fulvius) or the Texas coral snake (M fulvius tenere).

   
   
2. 
   

   May not be effective for envenomation by the western, Arizona, or Sonora coral snake (Micrurus euryxanthus), but symptomatic bites by these western US elapids are very rare.

Contraindications. Known hypersensitivity to Micrurus antivenom or to horse serum is a relative contraindication; if a patient with significant envenomation needs the antivenom, it should be given with caution. Antivenoms produced outside the United States may be made from horse or sheep serum.

Adverse effects

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