PROTAMINE

Standard Prescription

protamine __mg IV x 1 dose, infuse over _ minutes

Dosages

Heparin Reversal:
  Time since               Protamine dose
last heparin dose    mg/100 units heparin

< 30 min.                 1
30 - 60 min.             0.5 - 0.75
60 - 120 min.           0.375 - 0.5
> 120 min.               0.25 - 0.375

Maximum dose: 50 mg

Enoxaparin Reversal:
1 mg protamine per 1 mg of enoxaparin (if last dose of enoxaparin was given within 4 hr). If APTT still prolonged at 2 to 4 hrs may readminister 0.5mg protamine per 1 mg enoxaparin.

Mechanism of Action

Heparin reversal agent.

Forms Supplied

Injection: 50 mg/5 mL ampoule

Refrigeration required.

Comments

If anticoagulation with heparin needs to be discontinued for clinical reasons, termination of the heparin infusion will usually suffice due to rapid clearance of heparin.

May cause severe hypotension or cardiovascular collapse if given by rapid IV injection.

May cause hypersensitivity and anaphylaxis reactions (fish allergy is a risk factor).

Obtain APTT and PT 15 min. after the administration of protamine.

Protamine does not completely neutralize the anti-Xa activity of enoxaparin.

Heparin neutralization occurs within 5 minutes following IV administration.

References

90, 140

Last Edited

2018-07-26 22:48:43