We interviewed top toxicology experts with over 100 years of combined envenomation experience. They shared their wisdom and experience on envenomation management, the best clinical resources, and why they count on CroFab.
Thomas Arnold, MD, FAAEM, FACMT
Dr. Arnold is Professor and Chair, Department of Emergency Medicine at Louisiana State University – Shreveport. He has served as the Medical Director of the Louisiana Poison Center since 1994 and as a member of the Board of Directors for the American Association of Poison Centers for 3 terms.
William Banner, MD, PhD, FACMT
Dr. Banner is Medical Director of the Oklahoma Center for Poison and Drug Information. He practices Pediatric Critical Care, Medical Toxicology, and General Pediatrics and is board certified in Pediatric Critical Care Medicine.
Dr. Spencer Greene is a board-certified medical toxicologist and emergency physician. He is a Clinical Professor at the University of Houston College of Medicine and serves as the Director of Toxicology at HCA Houston Healthcare – Kingwood.
Dr. Greene lectures frequently across the country and has authored more than 50 textbook chapters and medical journal articles. He is the recipient of numerous teaching and clinical awards. His research interests include envenomations, antimuscarinic toxicity, anticonvulsant overdoses, salicylate poisoning, and alcohol withdrawal. He has directed the Houston Venom Conference since 2013.
Dr. Lavonas has published more than 20 articles about snake envenomation, including the Unified Treatment Algorithm for the Management of Crotaline Snakebite in the United States, which was selected as one of 50 Landmark Papers Every Acute Care Surgeon Should Know. In 2017, Dr Lavonas received the American College of Medical Toxicology’s Recognition Award for outstanding contributions to medical toxicology research.
Mark Ryan, PharmD
Dr. Ryan is currently the Managing Director for the Louisiana Poison Center. He has served as a member of the Board of Directors for the American Association of Poison Centers since 2012, serving as its president from 2018-2020.
1. CroFab®. Prescribing information. BTG International Inc.; August 2018.
CroFab® Crotalidae Polyvalent Immune Fab (Ovine) is a sheep-derived antivenin indicated for the management of adult and pediatric patients with North American crotalid envenomation. The term crotalid is used to describe the Crotalinae subfamily (formerly known as Crotalidae) of venomous snakes which includes rattlesnakes, copperheads and cottonmouths/water moccasins.
Important Safety Information
Do not administer CroFab® to patients with a known history of hypersensitivity to any of its components, or to papaya or papain unless the benefits outweigh the risks and appropriate management for anaphylactic reactions is readily available.
Warnings and Precautions
Coagulopathy: In clinical trials, recurrent coagulopathy (the return of a coagulation abnormality after it has been successfully treated with antivenin), characterized by decreased fibrinogen, decreased platelets, and elevated prothrombin time, occurred in approximately half of the patients studied; one patient required re-hospitalization and additional antivenin administration. Recurrent coagulopathy may persist for 1 to 2 weeks or more. Patients who experience coagulopathy due to snakebite should be monitored for recurrent coagulopathy for up to 1 week or longer. During this period, the physician should carefully assess the need for re-treatment with CroFab® and use of any type of anticoagulant or anti-platelet drug.
Hypersensitivity Reactions: Severe hypersensitivity reactions may occur with CroFab®. In case of acute hypersensitivity reactions, including anaphylaxis and anaphylactoid reactions, discontinue infusion and institute appropriate emergency treatment. Patients allergic to papain, chymopapain, other papaya extracts, or the pineapple enzyme bromelain may also have an allergic reaction to CroFab®. Follow-up all patients for signs and symptoms of delayed allergic reactions or serum sickness (e.g., rash, fever, myalgia, arthralgia).
The most common adverse reactions (incidence ≥ 5% of subjects) reported in the clinical studies were urticaria, rash, nausea, pruritus and back pain. Adverse reactions involving the skin and appendages (primarily rash, urticaria, and pruritus) were reported in 12 of the 42 patients. Two patients had a severe allergic reaction (severe hives and a severe rash and pruritus) following treatment and one patient discontinued CroFab® due to an allergic reaction. Recurrent coagulopathy due to envenomation and requiring additional treatment may occur.
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BTG® is a registered trademark of BTG International Ltd.
CroFab® is a registered trademark of BTG International Inc.
TIME IS TISSUE® is a trademark of Protherics Medicines Development Ltd., a SERB group company. SnakeBite911 and the snakehead logo are trademarks of Protherics UK Ltd. Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. Google Play and the Google Play logo are trademarks of Google Inc.
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