Protamine sulphate
Indications
Protamine sulphate is used for:
Used in the management of heparin overdose.
Adult Dose
Heparin Neutralization
1-1.5 mg per 100 USP units of heparin; not to exceed 50 mg
Monitor APTT 5-15 min after dose then in 2-8 hr
In accidental overdoses of heparin, consider t1/2 heparin 60-90 min
In setting without bleeding complications, consider observation, rather than reversal of anticoagulation with protamine (avoids ADR's)
Complex of protamine and heparin may degrade over time requiring further doses
Dalteparin or Tinzaparin Overdose
1 mg protamine for 100 units dalteparin or tinzaparin; if PTT prolonged 4hr after protamine overdose administer 0.5 mg per 100 units of dalteparin or tinzaparin
Enoxaparin Overdose
1 mg per mg enoxaparin (if enoxaparin overdose given within 8 hr); if >8 hr of overdose or bleeding continues after 4 hr after first dose, give 0.5 mg protamine per mg enoxaparin
Child Dose
Renal Dose
Administration
IV Preparation
Reconstitute with 5 mL sterile water
Resulting solution equals 10 mg/mL
IV Administration
Inject without further dilution over 1-3 min; maximum of 50 mg in any 10 min period
For IV use only
Contra Indications
Hypersensitivity
Precautions
Heparin rebound causing bleeding may occur 8-9 hr after protamine administration
May be ineffective in cardiac surgery patients despite adequate dose
Rapid infusion reactions can cause severe hypotensive reactions
Pregnancy-Lactation
Interactions
Adverse Effects
Side effects of Protamine sulphate :
Frequency Not Defined
Anaphylaxis
Hypotension
N/V
Decreased O2 consumption
Flushing
Pulmonary hypertension
Uncontrollable bleeding
Circulatory collapse
Pulmonary edema
Mechanism of Action
Protamine that is strongly basic combines with acidic heparin forming a stable complex and neutralizes the anticoagulant activity of both drugs