scott@vtx-cpd.com

Replying to Pauline Brauckmann 23/08/2025 - 18:55

Hi Pauline,

Great question. Denamarin is not a core therapy for snakebite, but it can be a reasonable adjunct after the acute phase in dogs that develop hepatic enzyme elevations or suspected oxidative hepatocellular injury. I have to be honest though, I have not seen many snake bites in the parts of the world I have practiced in! Where do you practice… If you say Australia, you will know significantly more than me! 🙂

In most canine envenomations the primary problems are neurotoxicity, hemotoxicity or myotoxicity depending on the species, together with shock, coagulopathy, local tissue damage, and secondary renal risk. The only treatment that changes outcomes consistently is timely antivenom, plus aggressive supportive care, analgesia, fluid therapy, control and monitoring of coagulopathy, and management of local tissue injury. Denamarin, which combines SAMe and silybin, is a hepatoprotective and antioxidant supplement; it does not neutralise venom and will not influence the immediate course of envenomation.

Where it can help is later, once the dog is stable and eating, if you see ALT or AST increases, hyperbilirubinaemia, or a pattern suggesting hepatocellular stress from hypoperfusion, haemolysis, drug exposure, or systemic inflammation. In that context a two to four week course is reasonable and safe in most dogs. Dose SAMe at about 18 to 20 mg per kg once daily on an empty stomach and aim to include a silybin component around 4 to 5 mg per kg daily, which Denamarin provides. Recheck liver enzymes in two to three weeks and stop if values normalise and the dog is clinically well.

If the dog is nauseous or not tolerating oral meds, skip it in hospital. Intravenous NAC is a better inpatient antioxidant for very sick dogs who cannot take tablets, but it is not an antidote for snake venom either; use it only when there is a separate indication for parenteral hepatic support.

If there is significant local necrosis, coagulopathy, rising CK or myoglobinuria, prioritise antivenom, fluids, pain control, wound care, and monitoring of PT aPTT platelets PCV TS creatinine CK and urine output. Add Denamarin later if liver values are abnormal once the dog is eating.

There is no strong evidence that prophylactic Denamarin in all snakebite cases improves outcomes. Reserve it for documented or strongly suspected liver involvement.

I hope that helps! Please let me know how you got on with the course and if you have any feedback!

Scott 🙂

Replying to Sarah Keir 02/09/2025 - 07:28

I think that is maybe part of the problem… everyone considers it to be a rubbish part of the job!?

I used to love being hidden away in the dental room in my PDSA days!

Teaching was certainly very limited when I was at vet school.

Scott

Replying to Sarah Keir 25/08/2025 - 15:35

This is great!

I love that! I will start doing that!

That is a whole social media campaign right there!

Scott 🙂

Replying to Sarah Keir 25/08/2025 - 15:27

Hey Sarah!

Thanks so much for your reply.

Following the most recent biopsy, I’ve opted for a preventative strategy focused on stabilising ALT and mitigating long-term hepatic damage. In terms of management, I’ve added:

Zinc supplementation at 8–10 mg/kg/day of elemental zinc, divided BID, to limit further copper uptake and enhance hepatic sequestration. We’ll monitor serum zinc to guide dosing and avoid toxicity.

Vitamin E at 10 IU/kg/day (capped at 400 IU), aiming to provide antioxidant and anti-fibrotic support.

Liver-specific diet: transitioning to Purina Liver Support (HP), primarily for its reduced copper content. I appreciated your point about protein levels, I’ve flagged this to the owners to monitor condition score and muscle mass. Fortunately, Anchor is in excellent condition and the food is well tolerated so far.

Continuing supportive therapies: Denamarin, ursodiol, vitamin B12 injections, taurine, and probiotics.

We’re planning to recheck ALT, AST, ALP, GGT, B12, and serum zinc 12 weeks after all changes are in place.

The owners were understandably a bit hesitant about corticosteroids for now, especially given how well Anchor looks clinically. That said, I’ve left the door open to revisit a steroid trial if ALT remains persistently elevated or if clinical signs evolve.

Hope all is well with you otherwise!

Scott 🙂

Replying to Julia Biernat 29/08/2025 - 09:53

Hey Julia!

I agree too! An interesting finding though.

I hope you are enjoying the course.

Scott 🙂