Snake antivenom is a medication made up of antibodies used to treat snake bites by venomous snakes. It is a type of

antivenom Antivenom, also known as antivenin, venom antiserum, and antivenom immunoglobulin, is a specific treatment for envenomation. It is composed of antibodies and used to treat certain venomous bites and stings. Antivenoms are recommended only if th ...

. It is a biological product that typically consists of venom neutralizing antibodies derived from a host animal, such as a horse or sheep. The host animal is hyperimmunized to one or more snake venoms, a process which creates an immunological response that produces large numbers of neutralizing antibodies against various components (toxins) of the venom. The antibodies are then collected from the host animal, and further processed into snake antivenom for the treatment of

envenomation Envenomation is the process by which venom is injected by the bite or sting of a venomous animal. Many kinds of animals, including mammals (e.g., the northern short-tailed shrew, ''Blarina brevicauda''), reptiles (e.g., the king cobra), spiders ...

. It is on the

World Health Organization's List of Essential Medicines The WHO Model List of Essential Medicines (aka Essential Medicines List or EML), published by the World Health Organization (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health s ...

Production

Antivenoms are typically produced using a donor animal, such as a horse or sheep. The donor animal is hyperimmunized with non-lethal doses of one or more venoms to produce a neutralizing antibody response. Then, at certain intervals, the blood from the donor animal is collected and neutralizing antibodies are purified from the blood to produce an antivenom.

Regulations

*Human Medicine: In the United States, antivenom production and distribution is regulated by the

Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...

. * Veterinary Medicine: In the United States, antivenom production and distribution is regulated by the

United States Department of Agriculture The United States Department of Agriculture (USDA) is the federal executive department responsible for developing and executing federal laws related to farming, forestry, rural economic development, and food. It aims to meet the needs of com ...

's Center for Veterinary Biologics.

Classification

Monovalent vs. polyvalent

Snake

can be classified by which antigens (venoms) were used in the production process. If the hyperimmunizing venom is obtained from a single species, then it is considered a monovalent antivenom. If the antivenom contains neutralizing antibodies raised against two or more species of snakes, then the composition is considered polyvalent.

Antibody composition

Compositions of the antivenom can be classified as whole IgG, or fragments of IgG. Whole antibody products consist of the entire antibody

molecule A molecule is a group of two or more atoms held together by attractive forces known as chemical bonds; depending on context, the term may or may not include ions which satisfy this criterion. In quantum physics, organic chemistry, and bioche ...

, often immunoglobulin G (IgG), whereas antibody fragments are derived by digesting the whole IgG into Fab (monomeric binding) or F(ab')2 (dimeric binding). The fragment antigen binding, or Fab, is the selective antigen binding region. An antibody, such as IgG, can be digested by papain to produce three fragments: two Fab fragments and one Fc fragment. An antibody can also be digested by

pepsin Pepsin is an endopeptidase that breaks down proteins into smaller peptides. It is produced in the gastric chief cells of the stomach lining and is one of the main digestive enzymes in the digestive systems of humans and many other animals, w ...

to produce two fragments: a F(ab')₂ fragment and a pFc' fragment. The fragment antigen-binding (Fab fragment) is a region on an antibody that binds to antigens, such as venoms. The molecular size of Fab is approximately 50kDa, making it smaller than F(ab')₂ which is approximately 110kDa. These size differences greatly affect the tissue distribution and rates of elimination.

Cross neutralization properties

Antivenoms may also have some cross protection against a variety of venoms from snakes within the same family or genera. For instance, Antivipmyn (Instituto Bioclon) is made from the venoms of

Crotalus durissus ''Crotalus durissus'', known as the South American rattlesnake, tropical rattlesnake,Mehrtens JM. 1987. Living Snakes of the World in Color. New York: Sterling Publishers. 480 pp. and by other names, is a highly venomous pit viper species found ...

and

Bothrops asper Terciopelo (''Bothrops asper'') is a species of pit vipers occurring at low to moderate elevations in northeast Mexico and Central America, and into South America where it is known from elevations up to 2600 meters in the Colombian and Ecuado ...

. Antivipmyn has been shown to cross neutralize the venoms from all North American pit vipers. Cross neutralization affords antivenom manufacturers the ability to hyperimmunize with fewer venom types to produce geographically suitable antivenoms.

Availability

Snake antivenom is complicated for manufacturers to produce. When weighed against profitability (especially for sale in poorer regions), the result is that many snake antivenoms, world-wide, are very expensive. Availability, from region to region, also varies.

Antivenom shortage for New World coral snake

, the relative rarity of coral snake bites, combined with the high costs of producing and maintaining an antivenom supply, means that antivenom (also called "antivenin") production in the United States has ceased. According to Pfizer, the owner of the company that used to make the antivenom Coralmyn, it would take between $5–$10 million for researching a new synthetic antivenom. The cost was too high in comparison to the small number of cases presented each year. The existing American coral snake antivenom stock technically expired in 2008, but the U.S. Food and Drug Administration has extended the expiration date every year through to at least 30 April 2017. Foreign pharmaceutical manufacturers have produced other coral snake antivenoms, but the costs of licensing them in the United States have stalled availability. Instituto Bioclon is developing a coral snake antivenom. In 2013, Pfizer was reportedly working on a new batch of antivenom but had not announced when it would become available. , the Venom Immunochemistry, Pharmacology and Emergency Response (VIPER) institute of the University of Arizona College of Medicine was enrolling participants in a clinical trial of INA2013, a "novel antivenom," according to the Florida Poison Information Center.

Families of venomous snakes

Over 600 species are known to be venomous—about a quarter of all snake species. The following table lists some major species.