Dosing and Administration

Appropriate Dosing of CroFab® Achieves Initial and Sustained Control of Envenomation¹

CroFab^® should be administered as soon as possible in patients with any sign of envenomation (e.g., local, systemic, or hematologic effects) to prevent clinical deterioration.

• Administer an initial dose of 4-6 vials* and monitor for signs of progression

• Administer an additional 4-6 vials if initial control is not achieved ~1 hr after initial dose

• Once initial control is achieved, administer an additional 2 vials every 6 hr for up to 18 hr (total of 3 doses)

• Scheduled maintenance dosing reduced the incidence of coagulation abnormalities due to residual venom

In pre- and postmarketing studies, 67-88% of patients achieved initial control with an initial dose of 4-6 vials when given according to recommended dosing.^2,3

*Initial dose may vary from 4-12 vials based on clinical judgment and severity of envenomation. Dosing is the same in adult and pediatric patients.
 

^†Efficacy determined using the snakebite severity score (SSS), a validated objective tool for the clinical evaluation of North American pit viper snakebite in adults. The total score reflects patient evaluation on 6 dimensions: cardiovascular system, local wound, gastrointestinal system, hematologic symptoms, pulmonary system, and central nervous system. The higher the total score, the more severe the snakebite.¹

Watch Dr. William Banner discuss his approach to dosing antivenom for children.

Administering CroFab^® to Achieve Control¹:

• Establish IV access and give IV fluids
• Initiate first dose of CroFab^® in ED or ICU
• Mix 4-6 vials^‡ of CroFab^® in 250 mL normal saline (0.9% sodium chloride)
• Infuse over 60 minutes, proceeding slowly over the first 10 minutes at a 25- to 50-mL/hour rate with careful observation for any allergic reaction
• If no allergic reaction occurs, increase infusion rate to the full 250 mL/hour until completion
• Close patient monitoring is necessary

• Postmarketing data showed low rates of hypersensitivity reactions (1.4% and 2.7%) in two studies including 1340 and 373 patients, respectively^4,5

• For patients in shock or with serious active bleeding, call physician-expert
• For suspected adverse reaction: Hold infusion, treat accordingly, and call physician-expert

• Re-examine patient for treatment response within 1 hour of completion of CroFab^® infusion

^‡Initial dose may vary from a minimum of 4 to a maximum of 12 vials based on clinical judgment and severity of envenomation.