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Indications

• Snake bites
• Botulism
• Diphtheria
• Tetanus
• Rabies exposure

Dosage

Children: Dosage for children varies based on the specific antiserum and condition being treated. Refer to specific guidelines for the type of antiserum used.

Adults: Dosage varies based on the specific antiserum and condition being treated. Refer to specific guidelines for the type of antiserum used.

Mechanism of action

Antiserum works by providing pre-formed antibodies that can bind to specific antigens, such as toxins or pathogens, neutralizing their effects and facilitating their clearance from the body. This rapid response helps to prevent or mitigate disease symptoms associated with the specific infection or toxin.

Pharmacodynamics

The pharmacodynamics of antiserum involves the interaction of antibodies with their corresponding antigens. Upon administration, the antibodies bind to the antigens, forming immune complexes that can activate the complement system and facilitate opsonization and phagocytosis by immune cells. This leads to a reduction in the severity of the disease and supports the immune system's ability to control the infection.

Pharmacokinetics

The pharmacokinetics of antiserum can vary based on the source and preparation of the serum. Generally, after intravenous or intramuscular administration, antibodies are distributed throughout the body, with peak concentrations occurring within hours. The half-life of antibodies can range from several days to weeks, depending on the specific type of antibody and the individual's immune response. Antiserum is typically metabolized and cleared by the reticuloendothelial system.

Adverse effects

• Anaphylaxis
• Serum sickness
• Fever
• Rash
• Joint pain
• Nausea

Interactions

• Anticoagulants may increase bleeding risk when used concurrently
• Immunosuppressive agents may diminish the efficacy of antiserum

Precautions

• Monitor for allergic reactions, especially in patients with a history of hypersensitivity
• Use with caution in patients with compromised immune systems
• Assess for previous exposure to the antiserum components

Pregnancy

Use only if the potential benefit justifies the potential risk to the fetus, as safety during pregnancy has not been established.

Breast-feeding

Use with caution, as it is not known if antiserum is excreted in human milk.

Storage

Store in a refrigerator at 2-8 degrees Celsius. Do not freeze. Protect from light.

Formulations

• Intravenous antiserum
• Intramuscular antiserum

Indications

• Management of Bitis snake bites
• Emergency treatment of envenomation
• Supportive care for symptoms of envenomation

Dosage

Children: For envenomation from Bitis species, immediate medical attention is required. Antivenom specific to the species involved should be administered, with dosing guided by weight and severity of symptoms

Adults: For envenomation from Bitis species, immediate medical attention is required. Antivenom specific to the species involved should be administered as per clinical guidelines. Dosing should be guided by the severity of symptoms and clinical protocols.

Mechanism of action

The venom of Bitis snakes primarily acts through the disruption of hemostasis and the induction of local tissue damage. It contains phospholipases, metalloproteinases, and neurotoxins that affect blood coagulation and nerve function. The metalloproteinases degrade proteins in the extracellular matrix, leading to tissue necrosis, while the phospholipases disrupt cell membranes, contributing to inflammation and pain.

Pharmacodynamics

The pharmacodynamics of Bitis venom involves a combination of anticoagulant, pro-inflammatory, and cytotoxic effects. The venom can cause a rapid onset of pain and swelling at the bite site, followed by systemic effects such as hypotension, coagulopathy, and shock. The severity of symptoms can vary based on the species of Bitis, the quantity of venom injected, and the location of the bite.

Pharmacokinetics

Due to the nature of venom, traditional pharmacokinetic parameters such as absorption, distribution, metabolism, and excretion do not apply. The effects of Bitis venom are immediate and localized at the site of envenomation, with systemic effects developing rapidly. The venom components may be metabolized by the body, but specific pharmacokinetic data on the elimination of venom components are limited.

Pregnancy

There is limited data on the safety of Bitis during pregnancy. Caution should be exercised.

Breast-feeding

It is unknown whether Bitis is excreted in human milk. Caution is advised while breastfeeding.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Indications

• Autism Spectrum Disorders
• Attention Deficit Hyperactivity Disorder (ADHD)
• Post-Traumatic Stress Disorder (PTSD)
• Anxiety Disorders
• Depression
• Cerebral Palsy
• Physical Rehabilitation

Dosage

Children: Refer to the specific therapeutic regimen determined by a healthcare professional, as equine therapy is individualized based on patient needs.

Adults: Refer to the specific therapeutic regimen determined by a healthcare professional, as equine therapy is individualized based on patient needs.

Mechanism of action

Equine therapy operates on several levels. The physical interaction with horses can enhance gross motor skills and encourage physical fitness. Psychologically, the bond formed between horse and human can foster emotional healing, reduce anxiety, and build confidence. The rhythmic motion of riding has been shown to have a calming effect on individuals, mimicking similar movements to those experienced in a therapeutic setting. Moreover, the social interaction involved in caring for and riding horses may improve communication skills and socialization.

Pharmacodynamics

Equine therapy itself does not involve pharmacological agents; however, it may influence the psychobiological pathways in the body. The interactions evoke hormonal responses that can alter levels of cortisol and adrenaline, enhancing relaxation and reducing stress. The therapeutic environment can also promote the release of endorphins, contributing to a sense of well-being and happiness.

Pharmacokinetics

As equine therapy does not involve drugs, pharmacokinetics is not applicable. However, the effects on the body can vary based on individual patient characteristics, the specific condition treated, and the duration and frequency of the therapy sessions. Factors such as age, physical condition, and psychological state can influence therapeutic outcomes.

Pregnancy

Equine products should be used with caution during pregnancy, as there is limited data on their safety. Consultation with a healthcare professional is recommended.

Breast-feeding

Safety during breastfeeding is not well established; therefore, caution is advised when using equine products in nursing mothers.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Indications

• Schizophrenia
• Psychotic disorders
• Severe anxiety and agitation
• Nausea and vomiting
• Intractable hiccups

Dosage

Adults: The usual starting dose for adults is 25 mg to 50 mg taken orally, which can be increased gradually to achieve the

Mechanism of action

Chlorpromazine acts as an antagonist on multiple postsynaptic receptors, including dopaminergic receptors (D1, D2, D3, D4), serotonergic receptors (5-HT1, 5-HT2), histaminergic receptors (H1), alpha-adrenergic receptors (alpha1, alpha2), and muscarinic receptors (M1, M2). This blockade leads to reduced dopaminergic activity, which alleviates psychotic symptoms, while the interaction with serotonergic and histaminergic receptors contributes to its anxiolytic, sedative, and antiemetic effects. Additionally, it has a weak presynaptic inhibitory effect on dopamine reuptake, providing mild antidepressive and antiparkinsonian effects.

Pharmacodynamics

Chlorpromazine primarily exhibits its effects at subcortical levels of the central nervous system. It is recognized for its strong antiadrenergic effects and weaker peripheral anticholinergic activity. The drug also shows slight antihistaminic and antiserotonin activity, contributing to its broad spectrum of effects on mood, behavior, and various physiological functions.

Pharmacokinetics

Chlorpromazine is well-absorbed following oral administration and is extensively metabolized in the liver. The drug's half-life varies significantly among individuals, typically ranging from 30 to 50 hours, but can be longer in some patients. It is primarily excreted in the urine as metabolites, with minimal unchanged drug being eliminated. The pharmacokinetics of chlorpromazine may be influenced by factors such as age, liver function, and concurrent medications.

Contra-indications

• Hypersensitivity to chlorpromazine or any of its components
• Comatose states
• Severe central nervous system depression
• Bone marrow depression
• Porphyria
• Severe liver dysfunction
• Pheochromocytoma

Adverse effects

• Sedation
• Weight gain
• Orthostatic hypotension
• Extrapyramidal symptoms
• Dry mouth
• Blurred vision
• Constipation
• Urinary retention
• Tachycardia
• Sexual dysfunction
• Akathisia
• Neuroleptic malignant syndrome

Interactions

• CNS depressants (e.g., alcohol, benzodiazepines) may enhance sedative effects
• Antihypertensive agents may have additive hypotensive effects
• Anticholinergic drugs may exacerbate anticholinergic effects
• Dopamine agonists may have reduced efficacy

Precautions

• Use with caution in patients with a history of seizures
• Monitor for signs of tardive dyskinesia
• Use cautiously in elderly patients, particularly those with dementia-related psychosis
• Regular monitoring of blood pressure is advised
• Consider the risk of metabolic syndrome

Pregnancy

Chlorpromazine should only be used in pregnancy if the potential benefit justifies the potential risk to the fetus. It is categorized as a pregnancy category C drug.

Breast-feeding

Chlorpromazine is excreted in breast milk. Caution should be exercised when administering to nursing mothers.

Storage

Store in a cool, dry place away from light. Keep out of reach of children.

Formulations

• Tablets (various strengths)
• Oral solution
• Injectable solution

Indications

• Primary immunodeficiency disorders
• Secondary immunodeficiency (e.g. due to HIV infection)
• Chronic inflammatory demyelinating polyneuropathy (CIDP)
• Immune thrombocytopenic purpura (ITP)
• Kawasaki disease
• Prevention of infections in at-risk populations (e.g. following bone marrow transplant)

Dosage

Children: Refer to the BNF for Children for age-appropriate dosing guidelines; specific doses depend on the clinical condition and patient age.

Adults: Refer to specific guidelines for dosing based on indication; typically varies based on clinical scenario and patient condition.

Mechanism of action

Immunoglobulin exerts its effects primarily through the neutralization of pathogens and toxins, opsonization, and the activation of the complement system. It modulates immune responses by influencing the activity of various immune cells, including B cells, T cells, and macrophages, thereby enhancing antibody production and regulating inflammation.

Pharmacodynamics

The pharmacodynamics of immunoglobulin involve its ability to bind to specific antigens, effectively neutralizing them and facilitating their clearance. It also plays a crucial role in modulating the immune response, providing immediate passive immunity and promoting the establishment of active immunity over time. The diverse mechanisms through which immunoglobulin operates include antibody-dependent cell-mediated cytotoxicity (ADCC) and inhibition of pro-inflammatory cytokines.

Pharmacokinetics

Immunoglobulin is typically administered intravenously or subcutaneously. After administration, it is distributed throughout the extracellular space. The half-life of immunoglobulin varies but is generally in the range of 21 to 30 days, depending on the specific formulation and the patient's individual characteristics. It is primarily eliminated through the reticuloendothelial system, with catabolism occurring in various tissues.

Contra-indications

• Hypersensitivity to immunoglobulin preparations
• Selective IgA deficiency with a history of hypersensitivity
• Severe hyperprolinemia

Adverse effects

• Headache
• Nausea
• Fever
• Chills
• Fatigue
• Rash
• Anaphylactic reactions
• Thromboembolic events

Interactions

• Live attenuated vaccines may be less effective if administered concurrently with immunoglobulin therapy
• Caution is advised when administering with other blood products

Precautions

• Monitor for signs of anaphylaxis during and after administration
• Use with caution in patients with renal impairment
• Hydrate adequately to prevent renal dysfunction
• Consider the risk of thrombosis in patients with a history of thromboembolic events

Pregnancy

Immunoglobulin can be used during pregnancy if indicated, as it is considered safe based on available data.

Breast-feeding

Immunoglobulin is excreted in breast milk, but is generally considered safe during breastfeeding.

Storage

Store at 2-8 degrees Celsius. Do not freeze. Protect from light. Use before expiry date.

Formulations

• Intravenous immunoglobulin (IVIG)
• Subcutaneous immunoglobulin (SCIG)
• Intramuscular immunoglobulin (IMIG)

Dosage

Children: Refer to specific medication guidelines for dosing in liters, as it varies widely based on the medication and clinical context.

Adults: Refer to specific medication guidelines for dosing in liters, as it varies widely based on the medication and clinical context.

Pregnancy

Safety in pregnancy has not been established. Use only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

It is not known if liters are excreted in human milk. Caution should be exercised when administering to nursing mothers.

Storage

Store in a cool, dry place, away from direct sunlight. Maintain at room temperature.

Indications

• Acute poisoning
• Drug overdose
• Toxin exposure
• Venomous bites
• Adverse drug reactions

Dosage

Children: Refer to specific neutralizing agent guidelines for dosing information.

Adults: Refer to specific neutralizing agent guidelines for dosing information.

Mechanism of action

Neutralizing agents typically bind to the target toxin or pathogen, rendering it inactive. This can occur through various mechanisms, such as chelation, where the neutralizer forms a complex with the toxin, or by blocking the receptor sites that the toxin would normally bind to. For example, in the case of an overdose of certain medications, an antidote may compete with the drug for binding sites or may facilitate the elimination of the toxin from the body.

Pharmacodynamics

The pharmacodynamics of neutralizing agents vary widely depending on the specific agent used and the type of toxin it is designed to counteract. Generally, these agents work rapidly to mitigate the effects of the toxin, leading to a reduction in symptoms and potential complications. The effectiveness of a neutralizer can depend on factors such as the dose of the toxin, the timing of administration, and the individual's response.

Pharmacokinetics

The pharmacokinetics of neutralizing agents also varies. Many are administered intravenously for rapid effect, while others may be given orally. Absorption, distribution, metabolism, and excretion can differ significantly between agents. Some neutralizers are excreted unchanged via the kidneys, while others may undergo biotransformation before elimination. The half-life of these agents can influence the duration of their action and may require multiple doses in certain cases.

Pregnancy

Consult a healthcare provider for advice regarding use during pregnancy, as safety data may vary depending on the specific substance being neutralized.

Breast-feeding

Consult a healthcare provider for advice regarding use while breastfeeding, as safety data may vary.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Indications

• Diagnostic blood tests
• Assessment of organ function
• Evaluation of electrolyte balance
• Monitoring of therapeutic drug levels
• Detection of antibodies or infectious agents

Dosage

Children: Dosage is not applicable as serum is a biological fluid used for diagnostic purposes and not an administered drug.

Adults: Dosage is not applicable as serum is a biological fluid used for diagnostic purposes and not an administered drug.

Mechanism of action

Serum itself does not have a specific mechanism of action as it is a biological fluid. However, its components, particularly proteins such as albumin and immunoglobulins, contribute to homeostasis, transport, and immune response. Albumin helps in maintaining oncotic pressure and transporting various substances, while immunoglobulins play a vital role in the immune response.

Pharmacodynamics

The pharmacodynamics of serum are closely related to its composition. The proteins in serum, including enzymes, hormones, and antibodies, exert various physiological effects. For example, serum albumin helps maintain blood volume and pressure, while globulins are involved in immune function. Changes in serum composition can affect the pharmacodynamics of drugs, influencing their distribution, metabolism, and elimination.

Pharmacokinetics

Serum does not follow a traditional pharmacokinetic profile, as it is a complex mixture rather than a single drug. However, the elimination and distribution of substances within the serum can be influenced by factors such as protein binding, blood flow, and the physiological state of the individual. The half-life of any drugs or substances present in serum will depend on their specific characteristics and interactions with serum components.

Adverse effects

• Allergic reactions
• Infection at the injection site
• Fever
• Rash
• Joint pain

Precautions

• Use with caution in individuals with a history of allergic reactions
• Monitor for signs of infection
• Assess for any history of autoimmune conditions

Pregnancy

Consult healthcare provider. Safety in pregnancy is not well established.

Breast-feeding

Consult healthcare provider. Limited information is available regarding excretion in breast milk.

Storage

Store at 2 to 8 degrees Celsius. Do not freeze. Protect from light.

Formulations

• Intravenous solution
• Subcutaneous injection

Indications

• Snake bites
• Envenomation
• Antivenom therapy
• Supportive care for systemic effects

Dosage

Children: For snake bites in children, refer to specific antivenom guidelines and local protocols. Dosing is typically adjusted based on weight and severity of envenomation.

Adults: For snake bites, refer to specific antivenom guidelines and local protocols. Dosing varies based on the type of snake, severity of envenomation, and clinical presentation.

Mechanism of action

The mechanisms of action of snake venom components vary widely. Neurotoxins interfere with neurotransmission by blocking acetylcholine receptors at the neuromuscular junction, leading to paralysis. Hemotoxins can disrupt blood coagulation pathways and damage blood vessels, causing hemorrhage and tissue necrosis. Cytotoxins can cause direct damage to cells and tissues, leading to pain and inflammation.

Pharmacodynamics

The pharmacodynamics of snake venom is characterized by its ability to interact with specific biological targets in the body, leading to a range of toxic effects. For example, neurotoxins can cause rapid onset of muscle paralysis, while hemotoxins can lead to bleeding and organ dysfunction. The effects depend on the dose, route of exposure, and individual susceptibility. The toxicity of snake venom can vary greatly between different species and individual snakes.

Pharmacokinetics

The pharmacokinetics of snake venom is not well characterized due to its complex nature and variability. Generally, venom components are rapidly absorbed into the bloodstream following envenomation. Distribution occurs systemically, affecting various tissues and organs. Metabolism can involve enzymatic breakdown by host tissues, while excretion pathways are not well defined. Severity of symptoms and toxicity can depend on the specific components of the venom and the patient's health status.

Adverse effects

• Local tissue necrosis
• Allergic reactions
• Systemic reactions
• Hemolysis
• Coagulation disorders

Precautions

• Use with caution in individuals with a history of allergic reactions to snake venom
• Monitor for signs of severe allergic reactions
• Assess local tissue condition after envenomation

Pregnancy

Safety during pregnancy is not established; use only if the benefits outweigh risks.

Breast-feeding

Safety during breastfeeding is not established; consult healthcare providers.

Storage

Store in a cool, dry place away from direct sunlight. Specific storage conditions may vary based on formulation.

Mechanism of action

Venoms exert their effects through various mechanisms, including enzymatic activity that disrupts cellular integrity, inhibition of neurotransmitter release, and modulation of ion channels. For example, neurotoxic venoms may block acetylcholine receptors at neuromuscular junctions, leading to paralysis. Other venoms can activate or inhibit specific receptors or pathways, resulting in pain, inflammation, or coagulation disturbances.

Pharmacodynamics

The pharmacodynamics of venom components depend on their specific targets and effects. Many venoms are designed to incapacitate prey quickly, with rapid onset of action. Effects may include paralysis, hemorrhage, or disruption of normal physiological functions. The potency and duration of action vary widely among different venoms and their constituent molecules.

Pharmacokinetics

Pharmacokinetics of venom components can vary significantly based on their structure and the route of exposure. After envenomation, the compounds may be rapidly absorbed into the bloodstream, leading to systemic effects. Metabolism typically occurs in the liver, and excretion can happen through urine or feces. The onset of action can be immediate, while the duration depends on the specific venom type and individual response.

Pregnancy

There is limited information on the use of venom during pregnancy. Use only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Caution is advised when using venom while breastfeeding due to the unknown effects on the infant.

Storage

Store in a cool, dry place, away from direct sunlight. Specific storage conditions may vary depending on the formulation.

Mechanism of action

Chlorpromazine acts as an antagonist (blocking agent) on different postsysnaptic receptors -on dopaminergic-receptors (subtypes D1, D2, D3 and D4 - different antipsychotic properties on productive and unproductive symptoms), on serotonergic-receptors (5-HT1 and 5-HT2, with anxiolytic, antidepressive and antiaggressive properties as well as an attenuation of extrapypramidal side-effects, but also leading to weight gain, fall in blood pressure, sedation and ejaculation difficulties), on histaminergic-receptors (H1-receptors, sedation, antiemesis, vertigo, fall in blood pressure and weight gain), alpha1/alpha2-receptors (antisympathomimetic properties, lowering of blood pressure, reflex tachycardia, vertigo, sedation, hypersalivation and incontinence as well as sexual dysfunction, but may also attenuate pseudoparkinsonism - controversial) and finally on muscarinic (cholinergic) M1/M2-receptors (causing anticholinergic symptoms like dry mouth, blurred vision, obstipation, difficulty/inability to urinate, sinus tachycardia, ECG-changes and loss of memory, but the anticholinergic action may attenuate extrapyramidal side-effects). Additionally, Chlorpromazine is a weak presynaptic inhibitor of Dopamine reuptake, which may lead to (mild) antidepressive and antiparkinsonian effects. This action could also account for psychomotor agitation and amplification of psychosis (very rarely noted in clinical use). The principal pharmacologic effects of chlorpromazine are similar to those of other propylamino derivatives of phenothiazine. Chlorpromazine has strong anticholinergic and sedative effects and moderate extrapyramidal effects. Chlorpromazine has strong antiemetic and adrenergic blocking activity and weak ganglionic blocking, antihistaminic, and antiserotonergic activity. The development of phenothiazine derivatives as psychopharmacologic agents resulted from the observation that certain phenothiazine antihistaminic compounds produced sedation. In an attempt to enhance the sedative effects of these drugs, promethazine and chlorpromazine were synthesized. Chlorpromazine is the pharmacologic prototype of the phenothiazines. The pharmacology of phenothiazines is complex, and because of their actions on the central and autonomic nervous systems, the drugs affect many different sites in the body. Although the actions of the various phenothiazines are generally similar, these drugs differ both quantitatively and qualitatively in the extent to which they produce specific pharmacologic effects. /Phenothiazine General Statement/ In the CNS, phenothiazines act principally at the subcortical levels of the reticular formation, limbic system, and hypothalamus. Phenothiazines generally do not produce substantial cortical depression; however, there is minimal information on the specific effects of phenothiazines at the cortical level. Phenothiazines also act in the basal ganglia, exhibiting extrapyramidal effects. The precise mechanism(s) of action, including antipsychotic action, of phenothiazines has not been determined, but may be principally related to antidopaminergic effects of the drugs. There is evidence to indicate that phenothiazines antagonize dopamine-mediated neurotransmission at the synapses. There is also some evidence that phenothiazines may block postsynaptic dopamine receptor sites. However, it has not been determined whether the antipsychotic effect of the drugs is causally related to their antidopaminergic effects. Phenothiazines also have peripheral and/or central antagonistic activity against alpha-adrenergic, serotonergic, histaminic (H1-receptors), and muscarinic receptors. Phenothiazines also have some adrenergic activity, since they block the reuptake of monoamines at the presynaptic neuronal membrane, which tends to enhance neurotransmission. The effects of phenothiazines on the autonomic nervous system are complex and unpredictable because the drugs exhibit varying degrees of alpha-adrenergic blocking, muscarinic blocking,

Pharmacodynamics

Chlorpromazine is a psychotropic agent indicated for the treatment of schizophrenia. It also exerts sedative and antiemetic activity. Chlorpromazine has actions at all levels of the central nervous system-primarily at subcortical levels-as well as on multiple organ systems. Chlorpromazine has strong antiadrenergic and weaker peripheral anticholinergic activity; ganglionic blocking action is relatively slight. It also possesses slight antihistaminic and antiserotonin activity.