| Drug | Class | Adult | Paediatric | Notes |
|---|---|---|---|---|
| Indian Polyvalent Anti-Snake Venom (ASV)[1] | Equine F(ab')2 / IgG anti-venom | 10 vials reconstituted in 100 mL 0.9% saline IV over 30–60 min; repeat 10 vials every 6 h until 20WBCT coagulable and neurology improving (max ~30 vials) | Same dose as adults — venom dose is fixed, not weight-based | Covers four species (Russell's viper, cobra, krait, saw-scaled viper) in Indian polyvalent preparation; check expiry; reconstitute correctly; pre-medication and reaction monitoring |
| Adrenaline (anaphylaxis prophylaxis / treatment)[1] | Sympathomimetic | Pre-ASV: 0.25 mg SC or 1:1000 IM 5 min before ASV. Treatment of anaphylaxis: 0.5 mg IM repeated every 5 min as needed | 10 µg/kg IM (max 0.5 mg) | Subcutaneous pre-medication per Indian programme; full anaphylaxis kit and IV access at all times during ASV administration |
| Atropine + neostigmine (cobra envenomation)[1] | Anticholinergic + acetylcholinesterase inhibitor | Atropine 0.6 mg IV + neostigmine 1.5 mg IV; assess at 30 min; repeat as response | Atropine 50 µg/kg + neostigmine 0.04 mg/kg IV | Cobra envenomation neuroparalysis (post-synaptic); not effective in krait; combines with ASV; adequate atropinisation prevents bradycardia from neostigmine |
| Hydrocortisone + chlorphenamine (reaction)[1] | Glucocorticoid + antihistamine | Hydrocortisone 100 mg IV; chlorphenamine 10 mg IV | Hydrocortisone 4 mg/kg IV; chlorphenamine 0.2 mg/kg IV | Adjunct to adrenaline in delayed reactions; not substitute for adrenaline in anaphylaxis; serum sickness 7–10 days after ASV warrants oral steroid |
First aid, recognition of systemic envenomation, anti-snake venom administration, and supportive care for snakebite in adults and children.