Centipede Envenomation Medication

Updated: Jun 23, 2022
  • Author: Andrew G Park, DO, MPH, FAWM; Chief Editor: Joe Alcock, MD, MS  more...
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Medication Summary

Analgesics and local anesthetics are used to ameliorate the pain associated with these stings. No antivenoms exist for centipede stings.



Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort and have sedating properties, which are beneficial for patients who have sustained centipede envenomations.

Acetaminophen (Little Fevers Children's Fever/Pain Reliever, Little Fevers Infant Fever/Pain Reliever, PediaCare Single Dose Acetaminophen Fever Reducer/Pain Reliever)

Acetaminophen is the drug of choice to treat pain in patients with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or who are taking oral anticoagulants.

Acetaminophen with codeine (Tylenol #3)

This is indicated for the treatment of mild to moderate pain in adults. Codeine should be avoided in children because of variable metabolism and elevated risk of adverse effects, per a 2016 American Academy of Pediatrics Clinical Report.

Acetaminophen with hydrocodone (Vicodin)

This is indicated for the treatment of mild to moderate pain.



Class Summary

Antihistamines prevent histamine response in sensory nerve endings and blood vessels; they are more effective in preventing a histamine response than in reversing it. H2 antihistamines are useful in the treatment of anaphylactic reactions when used concomitantly with H1 antagonists. Many H2 blockers are available.

Diphenhydramine (Benedryl)

This agent is used for symptomatic relief of allergic symptoms caused by histamines released in response to allergens. Diphenhydramine is effective and widely available.



Class Summary

Tetanus immunization should be instituted following a centipede envenomation if not up to date.

Diphtheria-tetanus toxoid (dT)

Diphtheria-tetanus toxoid is used for passive immunization of any person with a wound that may be contaminated with tetanus spores.



Class Summary

Anesthetics are indicated for pain relief. They stabilize the neuronal membrane and prevent the initiation and transmission of nerve impulses, thereby producing local anesthetic action.

Lidocaine anesthetic

Lidocaine inhibits depolarization of type C sensory neurons by blocking sodium channels. Epinephrine prolongs analgesic effects and enhances hemostasis (maximum epinephrine dose 4.5-7 mg/kg).

Bupivacaine (Marcaine, Sensorcaine)

Bupivacaine may reduce pain by slowing nerve impulse propagation and reducing action potential, which, in turn, prevents initiation and conduction of nerve impulses. Epinephrine prolongs effects and enhances hemostasis (maximum epinephrine dose 4.5-7 mg/kg).


Nonsteroidal anti-inflammatory drugs (NSAIDs)

Class Summary

NSAIDs are most commonly used to relieve mild to moderate pain. Although effects of NSAIDs in the treatment of pain tend to be patient specific, ibuprofen is usually the drug of choice for initial therapy. Other options include fenoprofen, flurbiprofen, mefenamic acid, ketoprofen, indomethacin, and piroxicam.

Ibuprofen (Ibuprin, Advil, Motrin)

Ibuprofen is usually the drug of choice for the treatment of mild to moderate pain if no contraindications exist. It inhibits inflammatory reactions and pain, probably by decreasing prostaglandin synthesis.

Ketoprofen (Oruvail, Orudis, Actron)

Ketoprofen is used for the relief of mild to moderate pain and inflammation. Small dosages are initially indicated in small or elderly patients and in those with renal or liver disease. Doses greater than 75 mg do not increase therapeutic effects. Administer high doses with caution and closely observe the patient for response.

Flurbiprofen (Ansaid)

Flurbiprofen may inhibit cyclooxygenase, causing the inhibition of prostaglandin biosynthesis. These effects may result in analgesic, antipyretic, and anti-inflammatory activities.

Naproxen (Anaprox, Naprelan, Naprosyn)

Naproxen is used for the relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.

Mefenamic acid (Ponstel)

Mefenamic acid inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Indomethacin (Indocin)

Indomethacin is rapidly absorbed. Metabolism occurs in the liver by demethylation, deacetylation, and glucuronide conjugation. It inhibits prostaglandin synthesis.

Piroxicam (Feldene)

Piroxicam decreases the activity of cyclooxygenase, which, in turn, inhibits prostaglandin synthesis. These effects decrease the formation of inflammatory mediators.


Osmotic diuretics

Class Summary

In the setting of documented compartment syndrome, osmotic diuretics such as mannitol may, when combined with elevation of the extremity, obviate the need for fasciotomy if pressures respond rapidly (within 1 h of administration).

Mannitol (Osmitrol, Resectisol)

Mannitol is an osmotic diuretic. It inhibits tubular reabsorption of electrolytes by increasing the osmotic pressure of glomerular filtrate. It increases urinary output.