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Pronunciation: PRO-tuh-meen SULL-fate
Class: Heparin antagonist
- Injection 10 mg/mL
Neutralizes heparin by forming heparin-protamine complex.
May be partially metabolized or may be cleaved by fibrinolysin, thus freeing heparin.
Rapid, neutralization occurs within 5 min.
Duration is 2 h, dependent on body temperature.
Indications and Usage
Treatment of heparin overdose.
Dosage and AdministrationAdults
IV 1 mg for each 90 units of heparin derived from lung tissue or 115 units of heparin derived from intestinal mucosa. Because heparin disappears rapidly from circulation, the dose of protamine required decreases rapidly with time following IV injection of heparin. For example, if protamine is administered 30 min after heparin, ½ the usual dose may be sufficient. The dose of protamine should be determined by blood coagulation studies.
- When given via direct IV injection, use 10 mg/mL concentration and administer slowly over 1 to 3 min. No more than 50 mg should be given in any 10-min period.
- Protamine sulfate injection is not intended to be further diluted. If further dilution is desired, dilute with D5W or normal saline.
Store protamine sulfate injection in refrigerator (36° to 46°F). Do not freeze.
None well documented.
Protamine should not be mixed with other drugs without knowledge of their compatibility.
Laboratory Test Interactions
None well documented.
Hypotension; bradycardia; circulatory collapse.
Shortness of breath; pulmonary edema; acute pulmonary hypertension.
Anaphylaxis (severe respiratory distress, circulatory collapse, capillary leak, noncardiogenic pulmonary edema); transient flushing and feeling of warmth; back pain.
Category C .
Safety and efficacy not established.
Fatal anaphylaxis may occur.
Can occur along with myocardial failure and reduced cardiac output.
When used to neutralize large doses of heparin, protamine can be inactivated by blood; treatment consists of giving additional protamine.
High-protein noncardiogenic pulmonary edema has occurred with use of protamine in patients on cardiopulmonary bypass undergoing cardiovascular surgery.
Too rapid administration
Can result in severe hypotension and anaphylactoid reactions.
- Instruct patient to notify health care provider immediately if any bleeding occurs.
- Tell patient to report the following symptoms to health care provider: Shortness of breath, dizziness, or swelling.
- Advise patient to avoid activities that could damage blood vessels or precipitate bleeding (eg, shaving, vigorous brushing of teeth, ambulation) until risk of hemorrhage has passed.
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