Version May 2024
Scorpion envenomation: Note: Initiate therapy as soon as possible after scorpion sting in patients who develop clinically important signs of scorpion envenomation.
IV: Initial: 3 vials (containing ≤105 mg total protein [as of 6/2021 manufacturer's labeling, previous amount ≤57 mg] and ≥450 LD50 [mouse] neutralizing units); may administer additional vials in 1-vial increments every 30 to 60 minutes as needed. Typical dosage range: 1 to 5 vials (Boyer 2013; Hurst 2018).
There are no dosage adjustments provided in manufacturer's labeling.
There are no dosage adjustments provided in manufacturer's labeling.
(For additional information see "Centruroides (scorpion) antivenom: Pediatric drug information")
Scorpion envenomation: Infants, Children, and Adolescents: IV: Initial: 3 vials (containing ≤105 mg total protein [as of 6/2021 manufacturer's labeling, previous amount ≤57 mg] and ≥450 LD50 [mouse] neutralizing units) initiated as soon as possible after scorpion sting in patients who develop clinically important signs of envenomation; may administer additional vials in 1-vial increments every 30 to 60 minutes as needed; typical reported dosage range: 1 to 5 vials (Boyer 2013; Hurst 2018).
There are no dosage adjustments provided in manufacturer's labeling.
There are no dosage adjustments provided in manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Reported adverse reactions are for adults and pediatrics.
1% to 10%:
Dermatologic: Pruritus (2%), skin rash (3%)
Gastrointestinal: Diarrhea (1%), nausea (2%), vomiting (5%)
Nervous system: Fatigue (2%), headache (2%), lethargy (1%)
Neuromuscular & skeletal: Myalgia (2%)
Respiratory: Cough (1%), rhinorrhea (2%)
Miscellaneous: Fever (4%)
<1%: Hypersensitivity: Serum sickness-like reaction
Postmarketing: Cardiovascular: Chest tightness, palpitations
There are no contraindications listed within the manufacturer’s labeling.
Concern related to adverse effects:
• Acute hypersensitivity reactions: Derived from equine (horse) immune globulin F(ab’)2 fragments; anaphylaxis and anaphylactoid reactions are possible, especially in patients with known allergies to horse protein. However, due to the lower protein content, purity, and absence of the immunogenic Fc portion of the immunoglobulin, serious adverse events are uncommon; in a prospective study (n=1,534), the incidence of acute antivenom reactions and type 3 immune reactions was 0.2% (n=3) and 0.5% (n=8), respectively (Boyer 2013). Patients who have had previous treatment with Centruroides immune F(ab’)2 or other equine-derived antivenom/antitoxin may be at a higher risk for hypersensitivity reactions. In patients who develop an anaphylactic reaction, discontinue the infusion and administer emergency care. Immediate treatment (eg, epinephrine 1 mg/mL, corticosteroids, diphenhydramine) should be available.
• Delayed serum sickness: Delayed serum sickness may occur, usually within 2 weeks; monitor patients with follow-up visits for signs and symptoms (eg, arthralgia, fever, myalgia, rash).
Dosage form related issues:
• Cresol: Product may contain small amounts of cresol resulting from the manufacturing process; local reactions and myalgias may occur.
• Disease transmission: Product of equine (horse) plasma; may potentially contain infectious agents (eg, viruses) which could transmit disease.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Reconstituted, Intravenous [preservative free]:
Anascorp: (1 ea) [contains cresol]
No
IV: Administer over 10 minutes; monitor for return of symptoms of envenomation and repeat as needed. Medications (eg, epinephrine, corticosteroids, diphenhydramine) and equipment for resuscitation should be readily available in case of hypersensitivity reactions. Avoid IM since the time to peak blood concentration may be prolonged with this route of administration (Tuuri 2011; Vasquez 2010).
IV: Administer over 10 minutes; others have reported beginning infusion slower at 25 to 50 mL/hour and then double the rate every 5 minutes as tolerated (Tuuri 2011); monitor for return of symptoms of envenomation and repeat as needed. Medications (eg, epinephrine, corticosteroids, diphenhydramine) and equipment for resuscitation should be readily available in case of hypersensitivity reactions. IM administration should generally be avoided since the time to peak blood concentration may be prolonged with this route of administration (Tuuri 2011; Vasquez 2010). If unable to obtain intravenous access, intraosseous (full dose) and intramuscular (single vial dose) administration have been reported in a neonate and a 16 month old child (Hiller 2010).
Scorpion envenomation: Treatment of scorpion envenomation
None known.
There are no known significant interactions.
Animal reproduction studies have not been conducted.
Outcome data following use of Centruroides immune F(ab’)2 during pregnancy are limited (Boyer 2013).
Scorpion stings may be associated with adverse pregnancy outcomes, depending on the degree of envenomation (Dorce 2017; Shah 2016). In general, medications used as antidotes should take into consideration the health and prognosis of the patient; antidotes should be administered to pregnant patients if there is a clear indication for use and should not be withheld because of fears of teratogenicity (Bailey 2003). Pregnant patients experiencing severe pain refractory to reasonable doses of opioids or systemic effects (eg, loss of muscle control, respiratory distress) should be considered for antivenom therapy (Brown 2013; Shah 2016).
It is not known if this product is present in breast milk.
The manufacturer recommends caution be used if administered to a patient who is breastfeeding.
Signs and symptoms of envenomation (eg, opsoclonus, involuntary muscle movement, slurred speech, paresthesias, respiratory distress, salivation, frothy sputum, vomiting). Monitor for signs and symptoms of acute antivenom hypersensitivity reactions (eg, urticaria, dyspnea); follow-up visits for signs and symptoms of serum sickness (eg, arthralgia, fever, myalgia, rash).
Contains venom-specific F(ab’)2 fragments of IgG which bind and neutralize venom toxins; thereby helping to remove the toxin from the target tissue and eliminate it from the body.
Onset: Time to resolution of symptoms: Adults: 1.91 ± 1.4 hours; Children: 1.28 ± 0.8 hours; >95% of all patients will experience resolution of symptoms within 4 hours
Distribution: Vdss: 13.6 L ± 5.4 L
Half-life, elimination: 159 ± 57 hours
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