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Unified Treatment Algorithm

Get Familiar With the Unified Treatment Algorithm

The Unified Treatment Algorithm is a comprehensive procedure based on expert recommendations for proper treatment in the event of a pit viper snakebite.

Dr. Eric Lavonas discusses the treatment algorithm video thumbnail

Eric Lavonas, MD, FACEP, FACMT

Emergency Medicine & Medical Toxicology

Hear From the Lead Author of the Treatment Algorithm


“When treating a snakebite, there is a small window to provide care, and the importance of every decision is magnified.”

Review resources on the treatment algorithm for the management of crotaline snakebites.
 

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Interactive Treatment Algorithm




The interactive treatment algorithm can serve as a guide in preparation of and during snakebite envenomation.
 

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Full Treatment Poster




Be prepared at every stage of envenomation management with guidance from the algorithm poster.


 

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Full Treatment Algorithm Research Article


Read the clinical research behind the consensus treatment algorithm for the management of North American pit viper envenomation.

 

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This information is adapted from general advice from a panel of US snakebite experts convened in May 2010. No algorithm can anticipate all clinical situations. Other valid approaches exist, and deviations from this information based on individual patient needs, local resources, local treatment guidelines, and patient preferences are expected. This algorithm is not intended to represent a standard of care. For more information, please see the accompanying manuscript, available at www.biomedcentral.com.

Watch Dr. Eric Lavonas break down the reasoning behind the Unified Treatment Algorithm.

Did you know?


It has been estimated that 7000-8000 people are bitten by venomous snakes per year. The number of morbidities can be decreased with preparation for aggressive and immediate medical intervention. 

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Recommendations for the management of North American pit viper envenomation

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Appropriate dosing achieves initial and sustained control of envenomation 

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Real-world use supports improved outcomes with CroFab 

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References

  1. Frequently Asked Questions. Department of Wildlife Ecology and Conservation website. Accessed September 13, 2023. Ufwildlife.ifas.ufl.edu/venomous_snake_faqs.shtml

  2. CroFab®. Prescribing information. BTG International Inc.; August 2018.

Indication and Important Safety Information
Indication

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
Contraindications

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).

Adverse Reactions

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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