title: A Single Dose of Viperfav(TM) May Be Inadequate for Vipera ammodytes Snake Bite: A Case Report and Pharmacokinetic Evaluation.
abstract: Viperfav(TM) is a commercial F(ab')₂ antivenom prepared against European vipers venom. It is safe and effective for treating envenomation caused by Vipera aspis and Vipera berus. Therapeutic efficacy for treating Vipera ammodytes ammodytes (V. a. ammodytes) envenoming has not been yet described, although protective efficacy has been demonstrated in preclinical studies. We report on a 32-year-old man bitten by V. a. ammodytes who was treated with Viperfav™. Viperfav™ promptly reduced local extension and improved systemic pathological signs, but 24 h after the incident a recurrence of thrombocytopenia occurred despite a favorable pharmacokinetic profile with systemic clearance (1.64 (mL·h(-1))·kg(-1)) and elimination half-life (97 h) among the highest ever reported. The recommended dose of Viperfav™ for V. aspis and V. berus bites may be inadequate for serious V. a. ammodytes envenomations. Following V. a. ammodytes bite, serial blood counts and coagulation profiles should be performed to help guide Viperfav™ treatment, along with supplemental administration as indicated.
authors.affiliation: Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Rockefellerova 10, HR-10000 Zagreb, Croatia. tkurtovi@unizg.hr.
authors.forename: Tihana
authors.initials: T
authors.lastname: Kurtović
authors.affiliation: Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia. miran.brvar@kclj.si.|Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Zaloška cesta 4, 1000 Ljubljana, Slovenia. miran.brvar@kclj.si.
authors.forename: Miran
authors.initials: M
authors.lastname: Brvar
authors.affiliation: Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia. damjan.grenc@kclj.si.
authors.forename: Damjan
authors.initials: D
authors.lastname: Grenc
authors.affiliation: Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Rockefellerova 10, HR-10000 Zagreb, Croatia. beata.halassy@unizg.hr.
authors.forename: Maja
authors.initials: M
authors.lastname: Lang Balija
authors.affiliation: Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia. igor.krizaj@ijs.si.|Faculty of Chemistry and Chemical Technology, University of Ljubljana, Večna pot 113, 1000 Ljubljana, Slovenia. igor.krizaj@ijs.si.
authors.forename: Igor
authors.initials: I
authors.lastname: Križaj
authors.affiliation: Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Rockefellerova 10, HR-10000 Zagreb, Croatia. maja.langbalija@gmail.com.
authors.forename: Beata
authors.initials: B
authors.lastname: Halassy
mesh_terms: D000328:Adult; D000818:Animals; D000997:Antivenins / Q000008:administration & dosage* / Q000097:blood; D001772:Blood Cell Count; D001777:Blood Coagulation / Q000187:drug effects; D001780:Blood Coagulation Tests; D016903:Drug Monitoring / Q000379:methods; D006207:Half-Life; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage* / Q000097:blood; D008297:Male; D008657:Metabolic Clearance Rate; D012909:Snake Bites / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014757:Viper Venoms; D017819:Viperidae
chemical_list: D000997:Antivenins; D007140:Immunoglobulin Fab Fragments; D014757:Viper Venoms; C000613977:Viperfav
keywords: F(ab’)2 antivenom pharmacokinetics; Vipera ammodytes ammodytes envenomation; Viperfav™ antivenom treatment