Dosing and Administration
Dose and Administer CroFab® Appropriately to Gain and Continue Control of Envenomation1,2
- 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.
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
Watch a video on the reconstitution process for CroFab®.
1. CroFab® [prescribing Information]. BTG International Inc; January 2018. 2. Lavonas EJ, Ruha AM, Banner W, et al. Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop. BMC Emerg Med. 2011;11:2. 3. Schaeffer TH, Khatri V, Reifler LM, Lavonas EJ. Incidence of immediate hypersensitivity reaction and serum sickness following administration of crotalidae polyvalent immune Fab antivenom: a meta-analysis. Acad Emerg Med. 2012;19(2):121-131.