Dosing and Administration

Dose and Administer CroFab^® Appropriately to Gain and Continue Control of Envenomation^1,2

• Administer CroFab^® as soon as possible in patients who develop any signs of envenomation (eg, local injury, coagulation abnormality, or systemic signs of envenomation) to prevent clinical deterioration. CroFab^® was shown in clinical studies to be effective when given within 6 hours of snakebite
• CroFab^® is available as a lyophilized powder

Dosing to Gain Initial Control¹:

• Pediatric CroFab^® dose is the same as adult dose
• The starting dose of CroFab^® may vary from a minimum of 4 vials to a maximum of 12 vials based on clinical judgment and severity of envenomation
• If necessary, administer an additional 6 vials of CroFab^® ~1 hour after end of first infusion

Check for Signs of Initial Control

Signs of initial control include¹:

• Halting of the progression of local effects, such as edema and ecchymosis
• A clear trend toward improvement in coagulation abnormalities, such as thrombocytopenia and spontaneous bleeding
• Resolution of all systemic effects*, such as nausea, vomiting, dizziness, or tachycardia

Dosing to Continue Control¹:

Continue CroFab^® dosing to help prevent recurrent venom effects¹

• Treat adult and pediatric patients with scheduled maintenance dosing after initial control is established
• Administer an additional 2-vial dose of CroFab^® every 6 hours for up to 18 hours (a total of 3 doses)

Maintenance therapy is additional CroFab^® given after initial control to prevent recurrence of venom effects.

*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
  • Post-marketing data reports low rates of acute (8%) and delayed (13%) hypersensitivity³
• 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.