Role of hydrocortisone and pheniramine as prophylaxis against adverse drug reaction to snake antivenom


  • Arjimand Yaqoob Department of Neurology, SKIMS, Srinagar, Jammu and Kashmir, India
  • Showkat A. Mufti Department of Emergency Medicine, SKIMS, Srinagar, Jammu and Kashmir, India
  • Sharika Ashraf Department of Zoology, Kashmir University Srinagar, Jammu and Kashmir, India



Snakebite, Anti-snake venom, Acute kidney injury, Intra cranial hemorrhage


Background: Antivenom remains the primary treatment for any patient with serious snake envenomation and in most patients should be used whenever indicated. Reactions to most antivenom preparations are common. Evidence does not support routine pre-treatment with either antihistamines or corticosteroids.

Methods: This hospital based retrospective and prospective comparative study was conducted at Sher-i-Kashmir Institute of Medical Sciences, Srinagar. In our study 108 patients were studied. Patients in group A received premedication with injection hydrocortisone 100 mg and injection pheniramine 25 mg intravenous (IV) stat before anti-snake venom (ASV). Patients in group B did not receive any premedication. Adverse reactions to ASV was compared in two groups.

Results: Out of 108 patients, 105 (97.22%) required ASV. Fifty nine were retrospective cases (group A) who had received premedication with hydrocortisone and pheniramine. Forty six patients were studied prospectively, who received ASV (group B) with no premedication. In group A, no patient developed adverse reaction to ASV. 3 patients (6.52%) in group B developed adverse reaction to ASV.

Conclusions: Premedication with hydrocortisone and pheniramine do not prevent adverse reactions to ASV significantly. Adverse reactions to ASV were low in our study to comment fully on role of premedication to prevent these reactions.


Chippaux JP. Snake-bites: appraisal of the global situation. Bull World Health Organ. 1998;76:515.

World Health Organization. Prevalence of snake bite envenoming. Available at: snakebites/epidemiology/en. Accessed on 04 September 2021.

Warrell DA. Snake bite. Lancet. 2010;375:77.

Maduwage K, Buckley NA, de Silva HJ, Lalloo DG, Isbister GK. Snake antivenom for snake venom induced consumption coagulopathy. Cochrane Database Syst Rev. 2015;(6):CD011428.

Warrell DA. Envenoming and injuries by venomous and nonvenomous reptiles worldwide. In: Wilderness Medicine, 6th Edition. Auerbach PS, Editor. Elsevier Mosby, Philadelphia. 2012;1040.

White J. Overview of venomous snakes of the world. In: Medical Toxicology, 3rd Edition. Dart RC, Editor. Lippincott, Williams & Wilkins, Philadelphia. 2004;1543.

Lalloo DG, Theakston RD. Snake antivenoms. J Toxicol Clin Toxicol. 2003;41:277.

Premawardhena AP, de Silva CE, Fonseka MM, Gunatilake SB, de Silva HJ. Low dose subcutaneous adrenaline to prevent acute adverse reactions to antivenom serum in people bitten by snakes: randomised, placebo controlled trial. BMJ. 1999;318(7190):1041-3.

Gawarammana IB, Kularatne SA, Dissanayake WP, Kumarasiri RP, Senanayake N, Ariyasena H. Parallel infusion of hydrocortisone +/- chlorpheniramine bolus injection to prevent acute adverse reactions to antivenom for snakebites. Med J Aust. 2004;180(1):20-3.

Fan HW, Marcopito LF, Cardoso JL, França FO, Malaque CM, Ferrari RA, et al. Sequential randomised and double blind trial of promethazine prophylaxis against early anaphylactic reactions to antivenom for bothrops snake bites. BMJ. 1999;318(7196):1451-2.

Halesha BR, Harshavardhan L, Lokesh AJ, Channaveerappa PK, Venkatesh KBA. A study on the clinico-epidemiological profile and the outcome of snake bite victims in a tertiary care centre in southern India. J Clin Diagn Res. 2013;7(1):122-6.

Wanje SD, Gadekar RD. Clinical profile of snake bite cases in Marathwada, India. Indian J Fundament Appl Life Sci. 2011;1(4):93-9.

Seneviratne SL, Opanayaka CJ, Ratnayake NS, Kumara KE, Sugathadasa AM, Weerasuriya N, et al. Use of antivenom serum in snake bite: a prospective study of hospital practice in the Gampaha district. Ceylon Med J. 2000;45(2):65-8.






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