Protamine Sulphate, Inj

Antidote

Indications

Used to treat overdose of unfractionated or low molecular weight heparin.

Dosage

IV: Overdosage with IV inj of unfractionated heparin: Adults: 1 mg neutralises 80-100 units of heparin, when given within 15 min of heparin; if longer than 15 min, since heparin, less protamine required. (SEE literature for details) as heparin rapidly excreted; max 50 mg. Overdosage with IV infusion of unfractionated heparin, by IV inj (rate not exceeding 5 mg/min): Adults: 25-50 mg once heparin infusion stopped. Overdosage with S/C injection of unfractionated heparin: Adults: 1 mg neutralises 100 units heparin; give 25-50 mg by IV inj (rate not exceeding 5 mg/min) then any remaining dose given by IV infusion over 8-16 hr; max total dose 50 mg. Overdosage with S/C inj of low molecular weight heparin, by intermittent IV inj (rate not exceeding 5 mg/min) or by continuous IV infusion: 1 mg neutralizes approx 100 units low molecular weight heparin (SEE literature of low molecular weight…

Administration

Protamine should be given by very slow IV injection over a 10-min period. Compatibility: Stable in NS, D5W. Incompatible with penicillins and several cephalosporins. Stability: Store at controlled room temperature 15°C-30°C (59°F-86°F). Do not permit to freeze. Diluted solutions should not be stored because they contain no preservative.

Adverse Effects

Nausea, vomiting, lassitude, flushing, hypotension, hypertension, bradycardia, dyspnoea, rebound bleeding, back pain, hypersensitivity reactions including angioedema, anaphylaxis and pulmonary oedema reported.

Risk Factor (Pregnancy/Lactation)

Precautions: Excessive dosage of protamine can have an anticoagulant effect. Monitor activated partial thromboplastin time or other appropriate blood clotting parameters; increased risk of allergic reactions to protamine (including previous treatment with protamine or protamine insulin, allergy to fish, men who are infertile or have had a vasectomy).

Pharmacokinetics

Onset of action: Heparin neutralization: Approx. 5 mins (IV). Metabolism: Protamine in the heparin-protamine complex may be partially metabolized or attacked by fibrinolysin, freeing heparin. Half-life elimination: Approx. 7 mins.

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.