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Antivenom, also known as antivenin, venom antiserum and antivenom immunoglobulin, is a medication made from antibodies which is used to treat certain venomous bites and stings.[1] They are recommended only if there is significant toxicity or a high risk of toxicity.[1] The specific antivenom needed depends on the species involved.[1] It is given by injection.[1]

Snake Milking.jpg
Milking a snake for the production of antivenom
Clinical data
Other namesantivenin, antivenene
Routes of
ATC code
  • none

Side effects may be severe.[1] They include serum sickness, shortness of breath, and allergic reactions including anaphylaxis.[1] Antivenom is made by collecting venom from the relevant animal and injecting small amounts of it into a domestic animal.[2] The antibodies that form are then collected from the domestic animal's blood and purified.[2] Versions are available for spider bites, snake bites, fish stings, and scorpion stings.[3]

Antivenom was first developed in the late 1800s and came into common use in the 1950s.[2][4] They are on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[5] Depending on the type, the wholesale cost in the developing world is US$9.00–118.80 per vial.[6] In the United States the wholesale cost is as high as $2,300 per dose.[7][8]

Medical usesEdit

Antivenom is used to treat certain venomous bites and stings.[1] They are recommended only if there is significant toxicity or a high risk of toxicity.[1] The specific antivenom needed depends on the species involved.[1]

In the US, approved antivenom include pit viper (rattlesnake, copperhead and water moccasin) snakebite is based on a purified product made in sheep known as CroFab.[9] It was approved by the FDA in October, 2000. U.S. coral snake antivenom is no longer manufactured, and remaining stocks of in-date antivenom for coral snakebite expired in the Fall of 2009, leaving the U.S. without a coral snake antivenom. 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.[10][11]

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.[12] Some promising research results have also been reported for administering the drug nasally as a "universal antivenom" for neurotoxic snakebite treatment.[13]

Antivenoms can be classified into monovalent (when they are effective against a single species' venom) or polyvalent (when they are effective against a range of species, or several different species at the same time).

The majority of antivenoms (including all snake antivenoms) 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.[14]

Antivenoms bind to and neutralize the venom, halting further damage, but do not reverse damage already done. Thus, they should be given as soon as possible after the venom has been injected, but are of some benefit as long as venom is present in the body. Since the advent of antivenoms, some bites which were previously invariably fatal have become only rarely fatal provided that the antivenom is given soon enough.

Side effectsEdit

Antivenoms are purified by several processes but will still contain other serum proteins that can act as antigens. Some individuals may react to the antivenom with an immediate hypersensitivity reaction (anaphylaxis) or a delayed hypersensitivity (serum sickness) reaction and antivenom should, therefore, be used with caution. Although rare, severe hypersensitivity reactions including anaphylaxis to antivenin are possible.[15] Despite this caution, antivenom is typically the sole effective treatment for a life-threatening condition, and once the precautions for managing these reactions are in place, an anaphylactoid reaction is not grounds to refuse to give antivenom if otherwise indicated. Although it is a popular myth that a person allergic to horses "cannot" be given antivenom, the side effects are manageable, and antivenom should be given as rapidly as the side effects can be managed.[16]


Antivenoms act by binding to and neutralizing venoms. The principle of antivenom is based on that of vaccines, developed by Edward Jenner; however, instead of inducing immunity in the person directly, it is induced in a host animal and the hyperimmunized serum is transfused into the person.[17] The host animals may include horses, donkeys, goats, sheep, opossums, rabbits, chickens, llamas, and camels.[citation needed] Antivenoms for medical use are often preserved as freeze-dried ampoules, but some are available only in liquid form and must be kept refrigerated. They are not immediately inactivated by heat, however, so a minor gap in the cold chain is not disastrous.

Some ophiophagic animals produce natural antidotes that render them immune to certain snake venoms. No human is immune to animal venom, but some individuals may be more or less susceptible to its effects.[18]

A person can build up immunity to a particular venom through frequent low and increasing doses (about every 21 days), but this immunity is only in effect while he or she is undergoing the dose regime.[18] According to the Greek history, King Mithridates did this in order to protect himself against attempts of poisoning, therefore this procedure is often called mithridatism. However, cytotoxic venom causes injury even at low doses meant to build resistance and the long-term effects of venom dosing in general have not been studied.[18] Thus, there is no practical purpose or favorable cost/benefit ratio for this, except for the people like zoo handlers, researchers, and circus artists who deal closely with venomous animals. Mithridatism has been tried with success in Australia and Brazil and total immunity has been achieved even to multiple bites of extremely venomous cobras and pit vipers.[citation needed]

Because neurotoxic venoms must travel farther in the body to do harm and are produced in smaller quantities, it is easier to develop resistance to them than directly cytotoxic venoms (such as those of most vipers) that are injected in large quantity and damage immediately upon injection.[citation needed]


The first antivenom for snakes (called an anti-ophidic serum) was developed by Albert Calmette, a French scientist of the Pasteur Institute working at its Indochine branch in 1895, against the Indian Cobra (Naja naja). 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 spiders, scorpions, and frogs.[citation needed] 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.[19]


There is an overall shortage of antivenom to treat snakebites. Because of this shortage, clinical researchers are looking at seeing if low doses can be as effective in severe neurotoxic snake envenoming.[20]

Internationally, antivenoms must conform to the standards of pharmacopoeia and the World Health Organization (WHO).[21] Antivenoms have been developed for the venoms associated with the following animals:[22]


Antivenom Species Country
Funnel web spider antivenom Sydney funnel-web spider Australia
Soro antiaracnidico Brazilian wandering spider Brazil
Soro antiloxoscelico Recluse spider Brazil
Suero antiloxoscelico Chilean recluse Chile
Aracmyn All species of Loxosceles and Latrodectus Mexico
Redback spider antivenom Redback spider Australia
Black widow spider (Latrodectus Mactans) antivenin (equine origin) Southern black widow spider United States
SAIMR spider antivenom Button spider South Africa
Anti-Latrodectus antivenom Black widow spider Argentina


Antivenom Species Country
Tick antivenom Paralysis tick Australia


Antivenom Species Country
soro antilonomico Lonomia obliqua caterpillar Brazil


Antivenom Species Country
INOSCORPI MENA (Middle East and North Africa) Androctonus australis, Androctonus mauritanicus, Androctonus crassicauda, Buthus occitanus mardochei, Buthus occitanus occitanus, Leiurus quinquestriatus quinquestriatus, Leiurus quinquestriatus hebreus Spain
Alacramyn Centruroides limpidus, C. noxius, C. suffusus Mexico
Suero Antialacran Centruroides limpidus, C. noxius, C. suffusus Mexico
Tunisian polyvalent antivenom All Iranian scorpions Tunisia
Anti-Scorpion Venom Serum I.P.(AScVS) Indian red scorpion India
Anti-scorpionique Androctonus spp., Buthus spp. Algeria
Scorpion antivenom Black scorpion, Buthus occitanus Morocco
Soro antiscorpionico Tityus spp. Brazil
SAIMR scorpion antivenin Parabuthus spp. South Africa
Purified prevalent Anti-Scorpion Serum(equine) Leiurus spp. and Androctonus scorpions Egypt

Marine animalsEdit

Antivenom Species Country
CSL box jellyfish antivenom Box jellyfish Australia
CSL stonefish antivenom Stonefish Australia


Antivenom Species Country
INOSERP MENA (Middle East and North Africa) Bitis arietans, Cerastes cerastes, Cerastes gasperettii,Cerastes vipera, Daboia deserti, Daboia mauritanica, Daboia palaestinae, Echis carinatus sochureki, Echis coloratus, Echis khosatzkii, Echis leucogaster, Echis megalocephalus, Echis omanensis, Echis pyramidum, Macrovipera lebetina obtusa, Macrovipera lebetina transmediterranea, Macrovipera lebetina turanica, Montivipera bornmuelleri, Montivipera raddei kurdistanica, Pseuocerastes fieldi, Pseudocerastes persicus, Vipera latastei, Naja haje, Naja nubiae, Naja pallida and Walterinnesia aegyptia Spain
INOSERP PAN-AFRICA (Sub-Sahara Africa) Echis ocellatus, Echis leucogaster, Echis pyramidum, Bitis arietans, Bitis rhinoceros, Bitis nasicornis, Bitis gabonica and Dendroaspis polylepis, Dendroaspis viridis, Dendroaspis angusticeps, Dendroaspis jamesoni, Naja nigricollis, Naja malanoleuca, Naja haje, Naja pallida, Naja nubiae, Naja katiensis and Naja senegalesis Spain
Polyvalent snake antivenom South American rattlesnake Crotalus durissus and fer-de-lance Bothrops asper Mexico (Instituto Bioclon); South America
Polyvalent snake antivenom Saw-scaled viper Echis carinatus, Russell's viper Daboia russelli, spectacled cobra Naja naja, common krait Bungarus caeruleus India
Death adder antivenom Death adder Australia
Taipan antivenom Taipan Australia
Black snake antivenom Pseudechis spp. Australia
Tiger snake antivenom Australian copperheads, tiger snakes, Pseudechis spp., rough-scaled snake Australia
Brown snake antivenom Brown snakes Australia
Polyvalent snake antivenom Many Australian snakes Australia
Sea snake antivenom Sea snakes Australia
Vipera tab Vipera spp. UK
Polyvalent crotalid antivenin (CroFab—Crotalidae Polyvalent Immune Fab (Ovine)) North American pit vipers (all rattlesnakes, copperheads, and cottonmouths) North America
Soro antibotropicocrotalico Pit vipers and rattlesnakes Brazil
Antielapidico Coral snakes Brazil
SAIMR polyvalent antivenom Mambas, cobras, Rinkhalses, puff adders (Unsuitable small adders: B. worthingtoni, B. atropos, B. caudalis, B. cornuta, B. heraldica, B. inornata, B. peringueyi, B. schneideri, B. xeropaga) South Africa[23]
SAIMR echis antivenom Saw-scaled vipers South Africa
SAIMR Boomslang antivenom Boomslang South Africa
Panamerican serum Coral snakes Costa Rica
Anticoral Coral snakes Costa Rica
Anti-mipartitus antivenom Coral snakes Costa Rica
Anticoral monovalent Coral snakes Costa Rica
Antimicrurus Coral snakes Argentina
Coralmyn Coral snakes Mexico
Anti-micruricoscorales Coral snakes Colombia


The name "antivenin" comes from the French word venin, meaning venom, which in turn was derived from Latin venenum, meaning poison.[citation needed]

Historically, the term antivenin was predominant around the world, its first published use being in 1895.[24] 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.[25]


  1. ^ a b c d e f g h i WHO Model Formulary 2008 (PDF). World Health Organization. 2009. pp. 396–397. ISBN 9789241547659. Archived (PDF) from the original on 13 December 2016. Retrieved 8 January 2017.
  2. ^ a b c Dart, Richard C. (2004). Medical Toxicology. Lippincott Williams & Wilkins. pp. 250–251. ISBN 9780781728454. Archived from the original on 2017-01-09.
  3. ^ British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 43. ISBN 9780857111562.
  4. ^ Gad, Shayne Cox (2007). Handbook of Pharmaceutical Biotechnology. John Wiley & Sons. p. 692. ISBN 9780470117101. Archived from the original on 2017-01-09.
  5. ^ "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016.
  6. ^ "Antivenom Serum". International Drug Price Indicator Guide. Archived from the original on 27 February 2017. Retrieved 8 December 2016.
  7. ^ Lewis, Danny (11 September 2015). "Why A Single Vial Of Antivenom Can Cost $14,000". Smithsonian. Retrieved 9 January 2017.
  8. ^ "One step closer to cheaper antivenom". ScienceDaily. 3 September 2015. Archived from the original on 9 January 2017. Retrieved 9 January 2017.
  9. ^ "Archived copy". Archived from the original on 2016-03-03. Retrieved 2016-02-08.CS1 maint: archived copy as title (link) Link to PDF for full prescribing information, retrieved 11/11/12
  10. ^ "CORAL SNAKE & ANTIVENOM FAQ's". Florida Poison Information Center - Tampa. May 2017. Retrieved October 31, 2019.
  11. ^ "North American Micrurus (Coral Snake Venoms)". Toxnet: Toxicology Data Network. September 15, 2015. Retrieved October 31, 2019.
  12. ^ Franklin, Deborah, "Potential Treatment For Snakebites Leads To A Paralyzing Test Archived 2014-08-09 at the Wayback Machine",, July 31, 2013.
  13. ^ "Universal antidote for snakebite: Experimental trial represents promising step Archived 2014-07-07 at the Wayback Machine", California Academy of Sciences via Science Daily, May 28, 2014.
  14. ^ Isbister GK. (2002). "Failure of intramuscular antivenom in Redback spider envenoming". Emerg Med (Fremantle). 14 (4): 436–9. doi:10.1046/j.1442-2026.2002.00356.x. PMID 12534488.
  15. ^ Bhoite RR, Bhoite GR, Bagdure DN, Bawaskar HS (2015). "Anaphylaxis to scorpion antivenin and its management following envenomation by Indian red scorpion, Mesobuthus tamulus". Indian Journal of Critical Care Medicine. 19 (9): 547–549. doi:10.4103/0972-5229.164807. PMC 4578200. PMID 26430342.
  16. ^ See, for example, the Antivenom Precautions paragraph of the Medication section of James Forster (2006-03-14). "Snake Envenomations, Sea". eMedicine Emergency Medicine (environmental). Archived from the original on 26 June 2006. Retrieved 2006-06-25.
  17. ^ Gad, Shayne. Handbook of Pharmaceutical Biotechnology. p. 692.
  18. ^ a b c Kalyan kumar, B. (October 4, 2014). "ANTISNAKE VENOM SERUM (ASVS)". International Journal on Pharmaceutical and Biomedical Research(IJPBR). Vol. 1(3): 77 – via
  19. ^ "CSL antivenoms 1956". Power House Museum. Archived from the original on 7 August 2016. Retrieved 24 February 2017.
  20. ^ Agarwal, R; Aggarwal, AN; Gupta, D; Behera, D; Jindal, SK (June 2005). "Low dose of snake antivenom is as effective as high dose in patients with severe neurotoxic snake envenoming". Emergency Medicine Journal. 22 (6): 397–9. doi:10.1136/emj.2004.020727. PMC 1726801. PMID 15911942.
  21. ^ Theakston RD, Warrell DA, Griffiths E (April 2003). "Report of a WHO workshop on the standardization and control of antivenoms". Toxicon. 41 (5): 541–57. doi:10.1016/S0041-0101(02)00393-8. PMID 12676433.
  22. ^ "Appendix: Antivenom Tables". Clinical Toxicology. 41 (3): 317–27. 2003. doi:10.1081/CLT-120021117.
  23. ^ Spawls, S; Branch B (1995). The Dangerous Snakes of Africa. Ralph Curtis Books. Dubai: Oriental Press. p. 192. ISBN 0-88359-029-8.
  24. ^ "Antivenin". Merriam-Webster Dictionary.
  25. ^ World Health Organization (1981). Progress in the characterization of venoms and standardization of antivenoms. Geneva: WHO Offset Publications. p. 5. ISBN 92-4-170058-0.

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