Protamine sulfate
Protamine sulfate
Protamine sulfate
( PROH-tah-meen)
Pregnancy Category: C (Rx)

Classification: Heparin antagonist

Action/Kinetics: A strong basic polypeptide that complexes with strongly acidic heparin to form an inactive stable salt. The complex has no anticoagulant activity. Heparin is neutralized within 5 min after IV protamine. Duration: 2 hr (but depends on body temperature). The t 1/2 of protamine is shorter than heparin; thus, repeated doses may be required. Upon metabolism, the complex may liberate heparin (heparin rebound).

Uses: Only for treatment of heparin overdose.

Contraindications: Previous intolerance to protamine. Use to treat spontaneous hemorrhage, postpartum hemorrhage, menorrhagia, or uterine bleeding. Administration of over 50 mg over a short period.

Special Concerns: Use with caution during lactation. Safety and efficacy have not been determined in children. Rapid administration may cause severe hypotension and anaphylaxis.

Side Effects: CV: Sudden fall in BP, bradycardia, transitory flushing, warm feeling, acute pulmonary hypertension, circulatory collapse (possibly irreversible) with myocardial failure and decreased CO. Pulmonary edema in clients on cardiopulmonary bypass undergoing CV surgery. Anaphylaxis: Severe respiratory distress, capillary leak, and noncardiogenic pulmonary edema. GI: N&V.; CNS: Lassitude. Other: Dyspnea, back pain in conscious clients undergoing cardiac catheterization, hypersensitivity reactions.

Overdose Management: Symptoms: Bleeding. Rapid administration may cause dyspnea, bradycardia, flushing, warm feeling, severe hypotension, hypertension. In assessing overdose, there may be the possibility of multiple drug overdoses leading to drug interactions and unusual pharmacokinetics. Treatment: Replace blood loss with blood transfusions or fresh frozen plasma. Fluids, epinephrine, dobutamine, or dopamine to treat hypotension.

How Supplied: Injection: 10 mg/mL

Dosage
?Slow IV
Give no more than 50 mg of protamine sulfate in any 10-min period. One mg of protamine sulfate can neutralize about 90 USP units of heparin derived from lung tissue or about 115 USP units of heparin derived from intestinal mucosa. NOTE: The dose of protamine sulfate depends on the amount of time that has elapsed since IV heparin administration. For example, if 30 min has elapsed, one-half the usual dose of protamine sulfate may be sufficient because heparin is cleared rapidly from the circulation.