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Volume 17
Issue 11
10.3390/pharmaceutics17111431
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Clinical Efficacy and Pharmacokinetics of Antivenom Viperfav® in Vipera ammodytes ammodytes Envenomation

by
Tihana Kurtović
1,
Mojca Dobaja Borak
2,3,
Damjan Grenc
2,
Adrijana Leonardi
4,
Igor Križaj
4,
Boris Lukšić
5,6,
Beata Halassy
1 and
Miran Brvar
2,7,*
1
Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Rockefellerova 10, HR-10000 Zagreb, Croatia
2
Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Zaloška cesta 7, SI-1000 Ljubljana, Slovenia
3
Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000 Ljubljana, Slovenia
4
Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Jamova 39, SI-1000 Ljubljana, Slovenia
5
Clinical Department of Infectious Diseases, University Hospital of Split, Šoltanska 1, HR-21000 Split, Croatia
6
School of Medicine, University of Split, Šoltanska 2, HR-21000 Split, Croatia
7
Centre for Clinical Physiology, Faculty of Medicine, University of Ljubljana, Zaloška cesta 4, SI-1000 Ljubljana, Slovenia
*
Author to whom correspondence should be addressed.
Pharmaceutics 2025, 17(11), 1431; https://doi.org/10.3390/pharmaceutics17111431
Submission received: 16 September 2025 / Revised: 1 November 2025 / Accepted: 2 November 2025 / Published: 5 November 2025
(This article belongs to the Section Pharmacokinetics and Pharmacodynamics)
Versions Notes

Abstract

Background: In Europe, Vipera ammodytes ammodytes (Vaa, nose-horned viper) is considered the most venomous of the European vipers. The antivenom Viperfav®, composed of polyvalent equine F(ab′)2 fragments, is effective against Vipera aspis, Vipera berus and Vaa. Objectives: This study aimed to evaluate the clinical efficacy and pharmacokinetics of Viperfav in Vaa envenomations. Methods: Patients presenting with Vaa snakebite and treated with intravenous Viperfav were included. Clinical manifestations and laboratory findings were assessed on admission to the Emergency Department, prior to antivenom therapy, and monitored throughout hospitalization. Blood samples were collected on arrival and at defined intervals after Viperfav administration. Venom and antivenom concentrations in serum were determined by ELISA and subjected to pharmacokinetic analysis. Results: Twenty-one patients bitten by Vaa and classified with a severity score of 2b on the modified Audebert clinical severity scale received a single intravenous dose of Viperfav within 4 h of the bite. Viperfav attenuated the progression of local symptoms and prevented the development of new systemic manifestations. The serum concentrations of F(ab′)2 fragments reached 196 µg/mL, far exceeding the venom concentration at admission (35 ng/mL). The prolonged elimination half-life of Viperfav (49 h) corresponded with the absence of recurrent symptoms after a single dose. Bradycardia or hypotension occurred in 10% of patients; no cases of anaphylaxis or serum sickness were observed. Conclusions: A single intravenous dose of Viperfav demonstrated clinical efficacy and a favourable pharmacokinetic profile in Vaa envenomed patients when administered within hours of the bite.
Keywords: snakebite; antivenom; V. ammodytes; Viperfav; F(ab’)2 fragments; pharmacokinetics snakebite; antivenom; V. ammodytes; Viperfav; F(ab’)2 fragments; pharmacokinetics

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MDPI and ACS Style

Kurtović, T.; Dobaja Borak, M.; Grenc, D.; Leonardi, A.; Križaj, I.; Lukšić, B.; Halassy, B.; Brvar, M. Clinical Efficacy and Pharmacokinetics of Antivenom Viperfav® in Vipera ammodytes ammodytes Envenomation. Pharmaceutics 2025, 17, 1431. https://doi.org/10.3390/pharmaceutics17111431

AMA Style

Kurtović T, Dobaja Borak M, Grenc D, Leonardi A, Križaj I, Lukšić B, Halassy B, Brvar M. Clinical Efficacy and Pharmacokinetics of Antivenom Viperfav® in Vipera ammodytes ammodytes Envenomation. Pharmaceutics. 2025; 17(11):1431. https://doi.org/10.3390/pharmaceutics17111431

Chicago/Turabian Style

Kurtović, Tihana, Mojca Dobaja Borak, Damjan Grenc, Adrijana Leonardi, Igor Križaj, Boris Lukšić, Beata Halassy, and Miran Brvar. 2025. "Clinical Efficacy and Pharmacokinetics of Antivenom Viperfav® in Vipera ammodytes ammodytes Envenomation" Pharmaceutics 17, no. 11: 1431. https://doi.org/10.3390/pharmaceutics17111431

APA Style

Kurtović, T., Dobaja Borak, M., Grenc, D., Leonardi, A., Križaj, I., Lukšić, B., Halassy, B., & Brvar, M. (2025). Clinical Efficacy and Pharmacokinetics of Antivenom Viperfav® in Vipera ammodytes ammodytes Envenomation. Pharmaceutics, 17(11), 1431. https://doi.org/10.3390/pharmaceutics17111431

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