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Macrovipera lebetina
General Details, Taxonomy and Biology, Venom, Clinical Effects, Treatment, First Aid , Antivenoms
Macrovipera lebetina  ( Levantine Viper ) subsp.  lebetina   [ Original photo copyright © Dr Jurg Meier ]
Family: Viperidae
Subfamily: Viperinae
Genus: Macrovipera
Species: lebetina
Subspecies: lebetina
Common Names
( subsp. lebetina ) Levantine Viper , Blunt-nosed Viper
Western Europe
Taxonomy and Biology
Adult Length: 1.00 m
General Shape
Medium in length, cylindrical, stout bodied snake with a short tail that tapers abruptly. Can grow to a maximum of about 1.70 metres. Head is pear shaped when viewed from above, relatively long and distinct from neck. Snout is blunt. Canthus rostralis is distinct. Nostrils located laterally. Eyes are medium in size with vertically elliptical pupils. Dorsal scales are keeled, outer row smooth or less keeled. Ventrals not keeled. Dorsal scale count ( 23 to 25 ) - ( 23 to 27 ) - 19.
Mainly dry, rocky regions.
Nocturnal and terrestrial snake.
Feeds mainly on small mammals, lizards and occasionally birds.
Species Map
Small (Approx 20k) version
Average Venom Qty
75 to 150 mg ( dry weight ), Minton (1974) ( Ref : R000504 ).

Iran : 49 ± 16 mg ( n=9726 ) ( dry weight of milked venom ), Latifi (1984) ( Ref : R000482 ).
General: Venom Neurotoxins
Probably not present
General: Venom Myotoxins
Probably present, but not confirmed.
General: Venom Procoagulants
General: Venom Anticoagulants
Probably not present
General: Venom Haemorrhagins
Probably present
General: Venom Nephrotoxins
Probably not present
General: Venom Cardiotoxins
Probably not present
General: Venom Necrotoxins
Possibly present
General: Venom Other
Not present or not significant
Clinical Effects
General: Dangerousness
Severe envenoming possible, potentially lethal
General: Rate of Envenoming: Unknown but likely to be high
General: Untreated Lethality Rate: Unknown but has caused deaths
General: Local Effects
Marked local effects; pain, severe swelling, bruising, blistering, necrosis
General: Local Necrosis
Can be moderate to severe
General: General Systemic Effects
Variable non-specific effects which may include headache, nausea, vomiting, abdominal pain, diarrhoea, dizziness, collapse or convulsions
General: Neurotoxic Paralysis
Does not occur, based on current clinical evidence
General: Myotoxicity
Does not occur, based on current clinical evidence
General: Coagulopathy & Haemorrhages
Common, moderate to severe coagulopathy + haemorrhagins causing extensive bleeding
General: Renal Damage
Recognised complication, usually secondary to coagulopathy
General: Cardiotoxicity
Does not occur, based on current clinical evidence
General: Other
Shock secondary to fluid shifts due to local tissue injury is likely in severe cases
First Aid
Description: First aid for bites by Viperid snakes likely to cause significant local injury at the bite site (see listing in Comments section).
1. After ensuring the patient and onlookers have moved out of range of further strikes by the snake, the bitten person should be reassured and persuaded to lie down and remain still. Many will be terrified, fearing sudden death and, in this mood, they may behave irrationally or even hysterically. The basis for reassurance is the fact that many venomous bites do not result in envenoming, the relatively slow progression to severe envenoming (hours following elapid bites, days following viper bites) and the effectiveness of modern medical treatment.
2. The bite wound should not be tampered with in any way. Wiping it once with a damp cloth to remove surface venom is unlikely to do much harm (or good) but the wound must not be massaged.
3. All rings or other jewellery on the bitten limb, especially on fingers, should be removed, as they may act as tourniquets if oedema develops.
4. The bitten limb should be immobilised as effectively as possible using an extemporised splint or sling; if available, crepe bandaging of the splinted limb is an effective form of immobilisation.
5. If there is any impairment of vital functions, such as problems with respiration, airway, circulation, heart function, these must be supported as a priority. In particular, for bites causing flaccid paralysis, including respiratory paralysis, both airway and respiration may be impaired, requiring urgent and prolonged treatment, which may include the mouth to mask (mouth to mouth) technique of expired air transfer. Seek urgent medical attention.
6. Do not use Tourniquets, cut, suck or scarify the wound or apply chemicals or electric shock.
7. Avoid peroral intake, absolutely no alcohol. No sedatives outside hospital. If there will be considerable delay before reaching medical aid, measured in several hours to days, then give clear fluids by mouth to prevent dehydration.
8. If the offending snake has been killed it should be brought with the patient for identification (only relevant in areas where there are more than one naturally occurring venomous snake species), but be careful to avoid touching the head, as even a dead snake can envenom. No attempt should be made to pursue the snake into the undergrowth as this will risk further bites.
9. The snakebite victim should be transported as quickly and as passively as possible to the nearest place where they can be seen by a medically-trained person (health station, dispensary, clinic or hospital). The bitten limb must not be exercised as muscular contraction will promote systemic absorption of venom. If no motor vehicle or boat is available, the patient can be carried on a stretcher or hurdle, on the pillion or crossbar of a bicycle or on someone's back.
10. Most traditional, and many of the more recently fashionable, first aid measures are useless and potentially dangerous. These include local cauterization, incision, excision, amputation, suction by mouth, vacuum pump or syringe, combined incision and suction ("venom-ex" apparatus), injection or instillation of compounds such as potassium permanganate, phenol (carbolic soap) and trypsin, application of electric shocks or ice (cryotherapy), use of traditional herbal, folk and other remedies including the ingestion of emetic plant products and parts of the snake, multiple incisions, tattooing and so on.
Treatment Summary
Bites may cause mild to severe local effects, shock & coagulopathy. All cases should be managed as potentially severe. Shock should be monitored for and vigorously treated. Specific antivenom is available only for some Vipera species, but should be used in all but minor envenoming cases.
Key Diagnostic Features
Local pain, swelling, blistering, necrosis + coagulopathy, bleeding
General Approach to Management
All cases should be treated as urgent & potentially lethal. Rapid assessment & commencement of treatment including appropriate antivenom (if indicated & available) is mandatory. Admit all cases.
Antivenom Therapy
Antivenom is the key treatment for systemic envenoming. Multiple doses may be required.
1. Antivenom Code: SAfIPA02
Antivenom Name: Anti-viperin (Bivalent)
Manufacturer: Institut Pasteur d_Algerie
Phone: ++213-21-67-25-02
Address: Rue du Docteur Laveran,
16000 Alger
Country: Algeria
2. Antivenom Code: SAsRII02
Antivenom Name: Polyvalent Snake Antivenin
Manufacturer: Razi Serum and Vaccine Research Institute
Phone: +98 261 3119708
Address: Iran Karaj  P.O. Box : 31975/148  Post No. :3197619751
Country: I.R. Iran
3. Antivenom Code: SEuIZC01
Antivenom Name: Viper Venom Antitoxin, European
Manufacturer: Institute of Immunology, Inc.
Phone: ++385-1-468-4500
Address: PO Box 266
Rockefellerova Street 2
10000 Zagreb
Country: Croatia
4. Antivenom Code: SEuIIV01
Antivenom Name: Viper Venom Antitoxin
Manufacturer: Torlak, Institute of Immunology and Virology
Phone: +381-11-3976-674
Address: 458 Vojvode Stepe St.
11152 Belgrade
P.O. Box 1, Serbia and Montenegro
Country: Yugoslavia
5. Antivenom Code: SAfIPM02
Antivenom Name: Antiviperin Sera
Manufacturer: Institut Pasteur du Maroc
Phone: Tél standard +212 22 43 44 50
Tél Expertise +212 22 43 44 75
Tél Médical +212 22 43 44 68
Address: Place Louis Pasteur
20100 Casablanca Maroc
Country: Morocco
6. Antivenom Code: SAfIPT02
Antivenom Name: Antiviperin Sera
Manufacturer: Institut Pasteur du Tunis
Phone: ++21-61-283022
Address: 13 Place Pasteur,
B.P. 74
1002 Tunis-Belvedere,
Country: Tunisia
7. Antivenom Code: SAfVAC02
Antivenom Name: Polyvalent Snake Venom Antiserum
Manufacturer: VACSERA
Phone: (+20 2) 3761-1111
Address: 51 Wezaret El Zeraa St., Agouza, Giza, 22311
Country: Egypt
Macrovipera lebetina ( Levantine Viper ) subsp. lebetina [ Original photo copyright © Dr Jurg Meier ]
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