A pharmacological approach to first aid treatment for snakebite

Journal name:
Nature Medicine
Year published:
Published online

Snake venom toxins first transit the lymphatic system before entering the bloodstream. Ointment containing a nitric oxide donor, which impedes the intrinsic lymphatic pump, prolonged lymph transit time in rats and humans and also increased rat survival time after injection of venom. This pharmacological approach should give snakebite victims more time to obtain medical care and antivenom treatment.

At a glance


  1. Effects of topical application of GTNO on lymphatic transit times.
    Figure 1: Effects of topical application of GTNO on lymphatic transit times.

    Foot-to-groin lymphatic transit times in each of 15 human subjects with and without GTNO treatment and the mean ± s.e.m. transit time (n = 15; left). Foot-to-groin lymphatic transit times in rats (mean ± s.e.m.) treated with GTNO (n = 16) or control base ointment (right; n = 13; right-hand y axis applies to the rat data only).

  2. Effects of GTNO treatment on venom actions in anesthetized rats.
    Figure 2: Effects of GTNO treatment on venom actions in anesthetized rats.

    (a) Kaplan-Meier plot showing GTNO effects on the time to respiratory arrest after subcutaneous venom injection in the rat hind foot (n = 14 control; n = 19 GTNO). (b) Respiratory rate over time (mean ± s.e.m.). (c) 405-nm optical absorbance (relative units, RU) of plasma over time (mean ± s.e.m.) in control- (n = 6) and GTNO–treated rats (n = 7). Data comparison was made using two-way repeated-measures analysis of variance with Holm-Sidak post hoc tests (*P < 0.05, **P < 0.01, ***P < 0.001). Comparisons between venom + base ointment and venom + GTNO to the right of the dashed lines in b and c are all significantly different.


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Author information


  1. Department of Nuclear Medicine, John Hunter Hospital, New Lambton, New South Wales, Australia.

    • Megan E Saul
  2. Department of Nuclear Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.

    • Paul A Thomas
  3. School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia.

    • Peter J Dosen &
    • Dirk F van Helden
  4. School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.

    • Geoffrey K Isbister &
    • Ian M Whyte
  5. Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Waratah, New South Wales, Australia.

    • Geoffrey K Isbister,
    • Margaret A O'Leary &
    • Ian M Whyte
  6. School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia.

    • Sally A McFadden


M.E.S. conducted the human experiments. P.A.T. supervised the human experiments. P.J.D. conducted the rat experiments. G.K.I. provided expertise on rat experiments, supervised assays and assisted in drafting the manuscript and statistical advice. M.A.O. undertook the absorbance assays. I.M.W. provided input on the human experiments. S.A.M. undertook the statistical analysis and figure presentations. D.F.v.H. conceived of and directed the overall project, supervised the rat experiments, analyzed data and drafted the manuscript.

Competing financial interests

D.F.v.H. has an Australian patent application (no. 2007327538) for the use of nitric oxide donors as a first aid for treatment of venomous bites.

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