Box Jelly Fish Antivenom

Question 1

Drug Class of Box Jelly Fish Antivenom

Answer 1

Antivenom

Question 2

Presentation of Box Jelly Fish Antivenom

Answer 2

• Ampoule, 20,000 units/1.5 – 4 mL box jellyfish antivenom

Question 3

Schedule of Box Jelly Fish Antivenom

Answer 3

• S4 (Restricted drugs).

Question 4

Pharmacology of Box Jelly Fish Antivenom

Answer 4

Box jellyfish antivenom contains concentrated immunoglobulin that 
 acts to neutralise the toxins present in the venom of the box jellyfish (Chironex fleckeri )

Question 5

Metabolism of Box Jelly Fish Antivenom

Answer 5

Hepatic and in muscle tissue.

Question 6

Indications of Box Jelly Fish Antivenom

Answer 6

• Box jellyfish (Chironex fleckeri ) envenomation associated with any of the following:

• a patient currently in cardiac arrest
• decreased level of consciousness
• cardiac AND/OR respiratory distress or collapse
• total surface area affected greater than half 
 the surface area of one limb
• intractable pain unrelieved by icepacks, methoxyflurane AND/OR narcotic analgesia.

Question 7

Contraindications of Box Jelly Fish Antivenom

Answer 7

• KSAR or hypersensitivity to box jellyfish antivenom

Question 8

Precautions of Box Jelly Fish Antivenom

Answer 8

• The antivenom is a foreign protein, which can cause sensitisation, allergic reaction or anaphylaxis

Question 9

Side Effects of Box Jelly Fish Antivenom

Answer 9

• Allergic reaction including anaphylaxis 
 and delayed serum sickness
• Intense stinging sensation on injection

Question 10

Routes of Administration for Box Jelly Fish Antivenom

Answer 10

Intramuscular injection (IM)
Intravenous injection (IV)

Question 11

Onset time of Box Jelly Fish Antivenom IV

Answer 11

Not available

Question 12

Duration time of Box Jelly Fish Antivenom IV

Answer 12

Not available

Question 13

Half life of Box Jelly Fish Antivenom

Answer 13

Not available

Question 14

Special Notes of Box Jelly Fish Antivenom

Answer 14

• Box jellyfish antivenom is to be available at all coastal QAS 
 stations from Wide Bay LASN and north.
• The dose of antivenom is related to the dose of venom, 

not based on the size of the patient.
• At all times during antivenom therapy adrenaline must be 
 available in case of an anaphylactic reaction. If reaction occurs, immediately cease the administration of box jellyfish antivenom 
 and treat patient in accordance with CPG: Anaphylaxis and allergy.
• IV injection is the preferred route of administration for 
 all indications.
• If a patient is in cardiac arrest due to box jellyfish envenomation, 
 the box jellyfish antivenom is only to be administered following 
 the commencement of effective CPR, advanced life support 
 measures and administration of cardioactive drugs.
• Box jellyfish antivenom is not currently supplied by the 
 QAS – for procurement information please refer 

to the QAS Drug Management Code of Practice.
• Box jellyfish antivenom must be protected from light and stored between 2–8°C. DO NOT FREEZE.

Question 15

Adult Dose of Box Jelly Fish Antivenom IM
Box jellyfish (ChIronex fleckeri) envenomation
 associated with any of the following:
• Decreased level of consciousness
• Cardiac AND/OR respiratory distress or collapse
• Total surface area affected greater than half the surface 
 area of one limb
• Intractable pain unrelieved by icepacks, methoxyflurane 
 AND/OR narcotic analgesia

Answer 15

60,000 units

Single dose only.

Question 16

Adult Dose of Box Jelly Fish Antivenom IV
Box jellyfish (ChIronex fleckeri) envenomation
 associated with any of the following:
• Decreased level of consciousness
• Cardiac AND/OR respiratory distress or collapse
• Total surface area affected greater than half the surface 
 area of one limb
• Intractable pain unrelieved by icepacks, methoxyflurane 
 AND/OR narcotic analgesia

Answer 16

20,000 units
Infusion over 20 minutes.
Administer via SPRINGFUSOR® 30 mL 
 Single dose only.
Syringe preparation: Mix 20,000 units 
 of antivenom with sodium chloride 0.9% in a 30 mL SPRINGFUSOR® syringe to achieve a final concentration of 

20,000 units/20 mL. Administer via SPRINGFUSOR® at a rate of 60 mL/hour (over 20 minutes).

Question 17

Adult Dose of Box Jelly Fish Antivenom IV
Box jellyfish (Chironex fleckeri) envenomation
 associated with a patient currently in cardiac arrest

Answer 17

20,000 units
Slow push over 2–5 minutes.

Repeated immediately up to 2 times. 

Total maximum dose 60,000 units.
Syringe preparation: Mix 20,000 units 
 of antivenom with sodium chloride 0.9% 

to achieve a final concentration of 
 20,000 units/20 mL.

Question 18

Paediatric Dose of Box Jelly Fish Antivenom IM
Box jellyfish (ChIronex fleckeri) envenomation
 associated with any of the following:
• Decreased level of consciousness
• Cardiac AND/OR respiratory distress or collapse
• Total surface area affected greater than half the surface 
 area of one limb
• Intractable pain unrelieved by icepacks, methoxyflurane 
 AND/OR narcotic analgesia

Answer 18

60,000 units

Single dose only.

Question 19

Paediatric Dose of Box Jelly Fish Antivenom IV
Box jellyfish (ChIronex fleckeri) envenomation
 associated with any of the following:
• Decreased level of consciousness
• Cardiac AND/OR respiratory distress or collapse
• Total surface area affected greater than half the surface 
 area of one limb
• Intractable pain unrelieved by icepacks, methoxyflurane 
 AND/OR narcotic analgesia

Answer 19

20,000 units
Infusion over 20 minutes.
Administer via SPRINGFUSOR® 30 mL 
 Single dose only.
Syringe preparation: Mix 20,000 units 
 of antivenom with sodium chloride 0.9% in a 30 mL SPRINGFUSOR® syringe to achieve a final concentration of 

20,000 units/20 mL. Administer via SPRINGFUSOR® at a rate of 60 mL/hour (over 20 minutes).

Question 20

Paediatric Dose of Box Jelly Fish Antivenom IV
Box jellyfish (Chironex fleckeri) envenomation
 associated with a patient currently in cardiac arrest

Answer 20

20,000 units 

Slow push over 2–5 minutes.

Repeated immediately up to 2 times. 
 Total maximum dose 60,000 units.
Syringe preparation: Mix 20,000 units 
 of antivenom with sodium chloride 0.9%
to achieve a final concentration of 
 20,000 units/20 mL.