Protamine sulfate
(Redirected from Protamine)
Administration
- Type: Antidote
- Dosage Forms:
- Routes of Administration: IV
- Common Trade Names:
Adult Dosing
- Major bleeding due to unfractionated heparin:
- 1 mg IV for every 100 units of heparin infused in past 3h
- Do not infuse faster than 50mg/10min
- If it has been >30min since last heparin injection, 0.5mg may be sufficient
- Give slowly over 1-3min; do not exceed 50mg in any 10 minute period (anaphylaxis risk)
- Because half-life is short (7 min) may require second treatment
- Major bleeding due to low-molecular-weight heparin:
- Protamine is less effective for bleeding from LMWH than it is with heparin-induced bleeds
- Enoxaparin: 1 mg IV for every 1 mg enoxaparin administered in past 8h
- Dalteparin: 1 mg IV for every 100 anti-Xa international units of dalteparin
Pediatric Dosing
Safety/Efficacy not well established in pediatrics, but unofficial suggested dosing similar to adult dosing
Special Populations
- Pregnancy Rating: C
- Lactation risk: Infant risk cannot be ruled out
- Renal dosing: no adjustment
- Hepatic dosing: no adjustment
Contraindications
- Allergy to class/drug
Adverse Reactions
Serious
- Anaphylaxis(0.2% of patients), anaphylactoid reaction
- Circulatory collapse, capillary leak, bradyarrhythmia, hypotension
- Pulmonary edema
Common
- Flushing
- Dyspnea
- Nausea/vomiting
Pharmacology
- Half-life:
- ~7 minutes
- Metabolism:
- Excretion:
Mechanism of Action
- Weak anticoagulant, heparin antagonist
Comments
See Also
- Anticoagulant reversal, Unfractionated heparin reversal
- Unfractionated heparin, Low molecular weight heparin
References
- Protamine sulfate: Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019.