Formulary
Protamine sulfate: Indications, Dosing, Side Effects and Interactions
Protamine sulfate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Protamine sulfate: Indications, Dosing, Side Effects and Interactions
Protamine sulfate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Overdosage with intravenous injection of heparin**
- **Adult** (By Intravenous Injection): Dose to be administered at a rate not exceeding 5 mg/minute, 1 mg neutralises 80-100 units heparin when given within 15 minutes; if longer than 15 minutes since heparin, less protamine required (consult product literature for details) as heparin rapidly excreted; maximum 50 mg.
**Overdosage with intravenous infusion of heparin**
- **Adult** (By Intravenous Injection): 25-50 mg, to be administered once heparin infusion stopped at a rate not exceeding 5 mg/minute.
**Overdosage with subcutaneous injection of low molecular weight heparin**
- **Adult** (By Intravenous Injection, Or By Continuous Intravenous Infusion): Dose to be administered by intermittent intravenous injection at a rate not exceeding 5 mg/minute, 1 mg neutralises approx. 100 units low molecular weight heparin (consult product literature of low molecular weight heparin for details); maximum 50 mg.
**Overdosage with intravenous injection or intravenous infusion of heparin (less than 30 minutes lapsed since overdose) for protamine sulfate**
- **Child** (By intravenous injection): 1 mg (max. per dose 50 mg), to be administered at a rate not exceeding 5 mg/minute, to neutralise each 100 units of heparin.
**Overdosage with intravenous injection or intravenous infusion of heparin (if 30-60 minutes lapsed since overdose) for protamine sulfate**
- **Child** (By intravenous injection): 500-750 micrograms (max. per dose 50 mg), to be administered at a rate not exceeding 5 mg/minute, to neutralise each 100 units of heparin.
**Overdosage with intravenous injection or intravenous infusion of heparin (if 60-120 minutes lapsed since overdose) for protamine sulfate**
- **Child** (By intravenous injection): 375-500 micrograms (max. per dose 50 mg), to be administered at a rate not exceeding 5 mg/minute, to neutralise each 100 units of heparin.
**Overdosage with intravenous injection or intravenous infusion of heparin (if over 120 minutes lapsed since overdose) for protamine sulfate**
- **Child** (By intravenous injection): 250-375 micrograms (max. per dose 50 mg), to be administered at a rate not exceeding 5 mg/minute, to neutralise each 100 units of heparin.
**Overdosage with subcutaneous injection of heparin for protamine sulfate**
- **Child** (By intravenous injection, or by intravenous infusion): (max. per dose 50 mg), 50-100% of the total dose to be given by intravenous injection (rate not exceeding 5 mg/minute), then give any remainder of dose by intravenous infusion over 8-16 hours, 1 mg neutralises approx. 100 units of heparin.
**Overdosage with subcutaneous injection of low molecular weight heparin for protamine sulfate**
- **Child** (By intravenous injection, or by continuous intravenous infusion): (max. per dose 50 mg), to be administered by intermittent intravenous injection at a rate not exceeding 5 mg/minute or by continuous intravenous infusion, 1 mg neutralises approx. 100 units of low molecular weight heparin, consult product literature of low molecular weight heparin for details.
Cautions
Excessive doses can have an anticoagulant effect
Side effects
Rare or very rare Pulmonary oedema non-cardiogenic Frequency not known Acute pulmonary vasoconstriction; back pain; bradycardia; circulatory collapse; dyspnoea; fatigue; feeling hot; flushing; hypertension; hypotension; nausea; pulmonary hypertension; vomiting
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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