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Logo ECHIS CARINATUS (Saw-scaled viper) SNAKEBITE ANTISERUM

PROPRIETARY NAME:
ECHIS CARINATUS (Saw-scaled viper) SNAKEBITE ANTISERUM

DESCRIPTIVE NAME:
ECHIS CARINATUS EQUINE IMMUNOGLOBULINS

REGISTRATION NUMBER:
T516 (Act 101/1965)

PHARMACOLOGICAL CLASSIFICATION:
A30.2 ANTIBODIES

SCHEDULING STATUS:
S4

COMPOSITION:
Pepsin-refined immunoglobulins, prepared from the serum of horses that have been hyper-immunised with Echis Carinatus snake venom.

IDENTIFICATION:
A light yellowish to light brown liquid with a slight odour of the preservative Cresol.

PHARMACOLOGICAL ACTION:
Neutralises the venom of the saw-scaled viper (Echis Carinatus).

INDICATIONS:
For the treatment of the saw-scaled viper bite. It has considerable paraspecific potency against the venoms of Echis coloratus and the two Cerastes species.

CONTRA-INDICATIONS:
Significant allergic disease, or a history of an adverse reaction to the injection of serum.

DOSAGE AND DIRECTIONS FOR USE:
N.B. BEFORE INJECTING, CARRY OUT THE INITIAL FIRST AID PROCEDURES AS DETAILED BELOW:–
THE PRESSURE BANDAGE
In all cases of snake bite a broad bandage (preferably a crêpe bandage) should be applied as soon as possible around the limb, covering the bitten area and as much of the limb as possible. This may be supplemented with other material, e.g. a strip torn off a shirt. It should be applied as tightly as one would bind a sprained ankle. The limb must be kept as still as possible by splinting with wood, cardboard, rolled newspaper, or any available rigid material.

GENERAL TREATMENT
Keep the patient quiet and comfortably warm and avoid unnecessary movement. Small amounts of water, tea or coffee may be given and alcohol in moderation if the patient has no difficulty with breathing or swallowing. A patient suffering from a suspected or known echis bite, should be kept under observation for a few hours, and may be dismissed if there are no signs of poisoning. Echis Carinatus snake venom is Cytotoxic, and may result in hemorrhagic tendency, diminished or no prothrombin activity, local swelling at bitten extremity, pain, blisters near site of bite, necrosis, vomiting, renal failure, and hypotensive shock.

SERUM TREATMENT
If echis bite is suspected, inject as large dose of antiserum (4 to 6 amps) if there are signs of systemic poisoning or spreading local damage (progression of swelling judged by measurements of circumference at point marked on limb). Time permitting, unless serum was given before admission with no ill effect, a trial dose of 0,1 mL of serum diluted 1:10 in water for injection should be injected under the skin. If there is no untoward reaction within half an hour, 0,2 mL of undiluted serum could be given the same way, to be followed, if necessary, by the full dose intravenously if no reaction occurs to this trial dose.
The initial dose should be large, at least two ampoules, but the condition of the patient may demand the injection of up to four to five times as much. The serum should be at room temperature and should be injected intravenously very slowly, with the patient recumbent during the injection, and for at least one hour afterwards. The dose of serum required depends on the amount of venom injected by the snake, not on the size or mass of the victim, and should not be reduced in the case of children.

SIDE EFFECTS AND SPECIAL PRECAUTIONS:
The injection of even highly purified serum carries a risk of untoward reactions. The commonest is serum sickness which may occur about ten days after the injection but sometimes sooner. It is characterised by itching rashes and sometimes a rise in temperature and joint pains. Proper treatment (antihistaminics, steroids) should alleviate the symptoms.
A rare but far more serious complication is an acute serum reaction (anaphylaxis) with a sudden drop in blood pressure and collapse within a few minutes. The risk of this type of reaction in a healthy person is very slight but those with an allergic disposition, in particular a history of asthma or infantile eczema, should not receive serum unless it is absolutely necessary and then only with the greatest caution. Treatment for this condition includes the injection of adrenalin.

KNOWN SYMPTOMS OF OVERDOSAGE AND PARTICULARS OF ITS TREATMENT:
None. Treat symptomatically.

PRESENTATION:
10 mL Ampoules.

STORAGE INSTRUCTIONS:
Store at 2° C to 10° C.

NAME AND BUSINESS ADDRESS OF APPLICANT:
The South African Institute for Medical Research.
Rietfontein, Edenvale, Transvaal.
P.O. Box 28999, Sandringham, 2131

DATE OF PUBLICATION OF THIS PACKAGE INSERT:
undated

ECH-792

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