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Ceprotin Dosage

Generic name: PROTEIN C 500[iU] in 5mL;
Dosage form: injection

Medically reviewed by Drugs.com. Last updated on Jan 4, 2019.

For intravenous administration only.

Dose

  • Initiate treatment with CEPROTIN under the supervision of a physician experienced in replacement therapy with coagulation factors/inhibitors where monitoring of protein C activity is feasible.
  • The dose, administration frequency and duration of treatment with CEPROTIN depends on the severity of the protein C deficiency, the patient's age, the clinical condition of the patient and the patient's plasma level of protein C.
  • Adjust the dose regimen according to the pharmacokinetic profile for each individual patient. [See DOSAGE AND ADMINISTRATION: Protein C Activity Monitoring].

Table 1 provides the CEPROTIN dosing schedule for acute episodes, short-term prophylaxis and long-term prophylaxis.

Table 1 CEPROTIN Dosing Schedule for Acute Episodes, Short-term Prophylaxis and Long-term Prophylaxis*
Initial Dose Subsequent 3 Doses Maintenance Dose
NA = Not applicable; Q = every.
*
Dosing is based upon a clinical trial of 15 patients.
Adjust the dose according to the pharmacokinetic profile for each individual..
Continue CEPROTIN until desired anticoagulation is achieved..
Acute Episode / Short-term Prophylaxis 100-120 IU/kg 60 - 80 IU/kg
Q 6 hours
45 - 60 IU/kg
Q 6 or 12 hours
Long-term Prophylaxis NA NA 45 - 60 IU/kg
Q 12 hours
  • An initial dose of 100-120 IU/kg for determination of recovery and half-life is recommended for acute episodes and short-term prophylaxis.
  • Adjust the dose to maintain a target peak protein C activity of 100 %.
  • Continue the patient on the same dose after resolution of the acute episode to maintain trough protein C activity level above 25% for the duration of treatment.
  • In patients receiving prophylactic administration of CEPROTIN, higher peak protein C activity levels may be warranted in situations of an increased risk of thrombosis (such as infection, trauma, or surgical intervention). Maintenance of trough protein C activity levels above 25% is recommended.
  • These dosing guidelines are also recommended for neonatal and pediatric patients [See USE IN SPECIFIC POPULATIONS: Pediatric Use (8.4) and CLINICAL PHARMACOLOGY: Pharmacokinetics (12.3)].

Protein C Activity Monitoring

  • The measurement of protein C activity using a chromogenic assay is recommended for the determination of the patient's plasma level of protein C before and during treatment with CEPROTIN. The half-life of CEPROTIN may be shortened in certain clinical conditions such as acute thrombosis, purpura fulminans and skin necrosis. See CLINICAL PHARMACOLOGY: Pharmacokinetics (12.3). In the case of an acute thrombotic event, it is recommended that protein C activity measurements be performed immediately before the next injection until the patient is stabilized. After the patient is stabilized, continue monitoring the protein C levels to maintain the trough protein C level above 25%.
  • Patients treated during the acute phase of their disease may display much lower increases in protein C activity. Coagulation parameters should also be checked; however, in clinical trials data were insufficient to establish correlation between protein C activity levels and coagulation parameters.

Initiation of Vitamin K Antagonists

  • In patients starting treatment with oral anticoagulants belonging to the class of vitamin K antagonists, a transient hypercoagulable state may arise before the desired anticoagulant effect becomes apparent. This transient effect may be explained by the fact that protein C, itself a vitamin K-dependent plasma protein, has a shorter half-life than most of the vitamin K-dependent proteins (i.e. Factor II, IX and X).
  • In the initial phase of treatment, the activity of protein C is more rapidly suppressed than that of the procoagulant factors. For this reason, if the patient is switched to oral anticoagulants, protein C replacement must be continued until stable anticoagulation is obtained. Although warfarin-induced skin necrosis can occur in any patient during the initiation of treatment with oral anticoagulant therapy, individuals with severe congenital protein C deficiency are particularly at risk.
  • During the initiation of oral anticoagulant therapy, it is advisable to start with a low dose of the anticoagulant and adjust this incrementally, rather than use a standard loading dose of the anticoagulant.

Preparation

Reconstitution: Use Aseptic Technique

  1. Bring the CEPROTIN (powder) and Sterile Water for Injection, USP (diluent) to room temperature.
  2. Remove caps from the CEPROTIN and diluent vials.
  3. Cleanse stoppers with germicidal solution, and allow them to dry prior to use.
  4. Remove protective covering from one end of the double-ended transfer needle and insert exposed needle through the center of the diluent vial stopper.
  5. Remove protective covering from the other end of the double-ended transfer needle. Invert diluent vial over the upright CEPROTIN vial; then rapidly insert the free end of the needle through the CEPROTIN vial stopper at its center. The vacuum in the vial will draw in the diluent. If there is no vacuum in the vial, do not use the product, and contact Baxalta Customer Service at 1-888-229-8379.
  6. Disconnect the two vials by removing the needle from the diluent vial stopper. Then, remove the transfer needle from the CEPROTIN vial. Gently swirl the vial until all powder is dissolved. Be sure that CEPROTIN is completely dissolved; otherwise, active materials will be removed by the filter needle.

Administration

Administration: Use Aseptic Technique

Visually inspect CEPROTIN for particulate matter and discoloration prior to administration.

After reconstitution, the solution should be colorless to slightly yellowish and clear to slightly opalescent and free of visible particles. Do not use the solution if it does not meet this criteria. Administer CEPROTIN at room temperature not more than 3 hours after reconstitution.

  1. Attach the filter needle to a sterile, disposable syringe and draw back the plunger to admit air into the syringe.
  2. Insert the filter needle into the vial of reconstituted CEPROTIN.
  3. Inject air into the vial and then withdraw the reconstituted CEPROTIN into the syringe.
  4. Remove and discard the filter needle in a hard-walled Sharps container for proper disposal. Filter needles are intended to filter the contents of a single vial of CEPROTIN only.
  5. Attach a suitable needle or infusion set with winged adapter, and inject intravenously as instructed below under Administration by infusion.

Record the name and batch number of the product every time CEPROTIN is administered to a patient.

Administration by Infusion

Administer CEPROTIN at a maximum injection rate of 2 mL per minute except for children with a body weight of < 10 kg, where the injection rate should not exceed a rate of 0.2 mL/kg/minute.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.