Snake envenoming is a major health issue in Asia with potentially the highest mortality and morbidity in the world, particularly in South Asia. There are a range of vipers and elapids which vary across the continent but are summarised in the table. The taxonomy of pit vipers has changed significantly with the separation of American and Asian pit vipers and many snakes from the Trimeresurus genus being moved to new genera.

Table 1: A summary of the major Asian snakes, their clinical effects and antivenoms that are available. Detailed information on the distribution of each snake group is available at toxinology.com.
Common Name
Scientific Name
Clinical Effects
Antivenom1
Russell’s viper
Daboia russelli
VICC due to factor X and factor V activators, neurotoxicity2, rarely acute kidney injury, hypotension
Indian antivenoms3, Thai antivenom4; Myanmar Pharmaceutical Factory
Saw-scaled or Carpet Viper
Echis carinatus
VICC due to prothrombin activators, spontaneous haemorrhage (due to haemorrrhagins in the venom).
Indian antivenoms
Malayan pit viper
Calloselasma rhodostoma
VICC due to thrombin-like enzymes (Ancrod)
Thai antivenom
Asian pit vipers, green tree vipers and Asian lance-headed vipers
Trimeresurus spp.
Local tissue damage and VICC due to thrombin-like enzymes
Thai antivenom
Hump-nosed vipers
Hypnale spp.
Local tissue damage, mild or partial VICC and rarely acute kidney injury
No antivenom currently available but cross neutralisation with antivenom for Malayan Pit Viper
Kraits (common krait, banded krait,
Bungarus spp.
Neurotoxicity, minimal local effects and autonomic effects
Indian antivenoms3, Thai antivenom4
Cobras
Naja spp.
Neurotoxicity and local cytotoxic injury
Indian antivenoms3, Thai antivenom4; Myanmar Pharmaceutical Factory
King Cobra
Ophiophagus hannah
Local tissue injury and necrosis, neurotoxicity
Thai antivenom
Asian Moccasins
Gloydius spp.
VICC (probably thrombin like enzymes) and local tissue injury
No antivenom available
Sharp-nosed pitviper or Chinese Moccasin
Deinagkistrodon acutus
Coagulopathy and local tissue injury and necrosis
Chinese antivenom (two manufacturers).
1 More information on antivenoms available at the WHO website: http://apps.who.int/bloodproducts/snakeantivenoms/database/snakeframeset.html; 2 Neurotoxicity occurs mainly in South Asian Russell’s vipers; 3 There are a number of Indian antivenom manufacturers; 4 The manufacturer in Thailand is Queen Saovabha Memorial Institute which makes antivenoms for most snakes in Asia; VICC – venom induced consumption coagulopathy;