Abstract

Snakebite envenomation remains a critical yet neglected public health problem, particularly in South Asia, where cobra species of the genus Naja contribute substantially to morbidity and mortality. Among these, Naja n. karachiensis, the Pakistani black cobra, poses significant clinical and public health challenges. Conventional antivenom therapy, although life-saving, has limitations including adverse reactions, restricted availability in rural areas, and variable efficacy against geographically distinct venom phenotypes. These constraints have prompted growing interest in plant-based therapeutics as complementary or alternative interventions. This scoping review systematically collates and evaluates the available evidence on medicinal plants assessed for antivenom activity against N. naja karachiensis venom and its key enzymatic components, including phospholipase A₂, alkaline phosphatase, 5′-nucleotidase, and hemolytic factors. A comprehensive literature search was conducted across major scientific databases following PRISMA-ScR guidelines.

Studies published between 2010 and 2025 reporting experimental investigations of medicinal plants against N. n. karachiensis venom were included. Data was extracted on plant species, plant parts used, targeted venom components, and reported bioactivities. Multiple medicinal plants, including Albizia lebbeck, Citrus limon, Enicostema hyssopifolium, Terminalia arjuna, and Fagonia cretica, demonstrated significant inhibitory effects against key venom enzymes and protective activity against venom-induced hemolysis and tissue damage. Several species exhibited multi-target venom neutralization, likely due to synergistic actions of phytochemicals such as flavonoids, alkaloids, and phenolic compounds. Medicinal plants show substantial potential as complementary antivenom agents. However, further research is needed to isolate active compounds, standardize formulations, validate efficacy in vivo, and integrate with conventional antivenom therapies to optimize treatment outcomes in resource-limited settings.

Keywords:Naja naja karachiensis; Snakebite; Medicinal plants; Antivenom; PLA₂; Ethnopharmacology

Abbreviations: ALPase: Alkaline Phosphatase; IPD: In-Patient Department; N. n. karachiensis: Naja naja karachiensis; NTD: Neglected Tropical Disease; OSH: Occupational Safety and Health; PLA₂: Phospholipase A₂; RBC: Red Blood Cell; WHO: World Health Organization