The amount of venom produced by individual specimens is considerable. Reported venom yields for adult specimens range from 130–250 mg to 150–250 mg to 21–268 mg. For 13 juveniles with an average length of 79 cm, the average venom yield was 8–79 mg (mean 45 mg).

The LD in mice, which is used as a general indicator of snake venom toxicity, is as follows: 0.08–0.31 μg/g intravenous, 0.40 μg/kg intraperitoneal, 4.75 mg/kg subcutaneous. For most humans a lethal dose is 40–70 mg. In general, the toxicity depends on a combination of five different venom fractions, each of which is less toxic when tested separately. Venom toxicity also varies within populations and over time.

Envenomation symptoms begin with pain at the site of the bite, immediately followed by swelling of the affected extremity. Bleeding is a common symptom, especially from the gums, and sputum may show signs of blood within 20 minutes post-bite. There is a drop in blood pressure and the heart rate falls. Blistering occurs at the site of the bite, developing along the affected limb in severe cases. Necrosis is usually superficial and limited to the muscles near the bite, but may be severe in extreme cases. Vomiting and facial swelling occurs in about one-third of all cases.

Severe pain may last for 2–4 weeks. Locally, it may persist depending on the level of tissue damage. Often, local swelling peaks within 48–72 hours, involving both the affected limb and the trunk. If swelling up to the trunk occurs within 1–2 hours, massive envenomation is likely. Discoloration may occur throughout the swollen area as red blood cells and plasma leak into muscle tissue. Death from septicaemia, respiratory or cardiac failure may occur 1 to 14 days post-bite or even later.

Because this venom is so effective at inducing thrombosis, it has been incorporated into an in vitro diagnostic test for blood clotting that is widely used in hospital laboratories. This test is often referred to as Dilute Russell's viper venom time (dRVVT). The coagulant in the venom directly activates factor X, which turns prothrombin into thrombin in the presence of factor V and phospholipid. The venom is diluted to give a clotting time of 23 to 27 seconds and the phospholipid is reduced to make the test extremely sensitive to phospholipid. The dRVVT test is more sensitive than the aPTT test for the detection of lupus anticoagulant (an autoimmune disorder), because it is not influenced by deficiencies in clotting factors VIII, IX or XI.

In India, the Haffkine Institute prepares a polyvalent antivenin that is used to treat bites from this species.

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