Names and pronunciation
(proe′ta-meen)
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Drug reference
(proe′ta-meen)
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Func. class.: Heparin antagonist
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Chem. class.: Low-molecular-weight protein
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Do not confuse: protamine/Protonix
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ACTION: Binds heparin, thereby making it ineffective
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USES: Heparin, LMWH toxicity, hemorrhage
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CONTRAINDICATIONS:
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Black Box Warning: Hypersensitivity Precautions: Pregnancy, breastfeeding, fish allergy, diabetes, previous exposure to protamine, insulins, heparin rebound or bleeding Black Box Warning: Requires a special- ized care setting Black Box Warning: Hypersensitivity: urticaria, cough, wheezing, have emer- gency equipment nearby; allergy to fish; use with caution; men who have had va- sectomies may be more prone to hyper- sensitivity, also high doses • Blood studies (Hct, platelets, occult blood in stools) • Coagulation tests (aPTT, ACT) 15 min after dose, then again after several hours • VS, B/P, pulse after 30 min, then 3 hr after dose • Skin rash, urticaria, dermatitis • Pregnancy/breastfeeding: use only if clearly needed; cautious use in breast- feeding
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SIDE EFFECTS CV: Hypotension, bradycardia, circula- tory collapse, capillary leak P GI: Nausea, vomiting HEMA: Bleeding, heparin rebound (car- diac surgery) INTEG: Rash, dermatitis, urticaria RESP: Dyspnea, pulmonary edema, severe respiratory distress, bronchospasm SYST: Anaphylaxis, angioedema
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DOSAGE AND ROUTES Heparin overdose • Adult/child: IV 1 mg of protamine/100 units heparin given; administer slowly over 1-3 min; max 50 mg/10 min Enoxaparin overdose • Adult: IV 1 mg protamine/1 mg enoxa- parin Dalteparin overdose • Adult: IV 1 mg protamine/100 anti-Xa unit
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Available forms: Inj 10 mg/mL
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Administer: • Store at 36°F-46°F (2°C-8°C) Direct IV route • May give diluted or undiluted • After reconstituting 50 mg/5 mL sterile bacteriostatic water for inj; shake, give ≤20 mg over 1-3 min, do not give rapidly Y-site compatibilities: Alfentanil, amikacin, aminophylline, ascorbic acid, atracurium, atropine, azaTHIOprine, aztreonam, benz- tropine, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, cefTAZidime, chlorproMAZINE, cimetidine, clindamycin, cyanocobalamin, cycloSPO- RINE, digoxin, diphenhydrAMINE, DOBU- Tamine, DOPamine, doxycycline, enala- prilat, ePHEDrine, EPINEPHrine, epoetin alfa, erythromycin, esmolol, famotidine, fentaNYL, fluconazole, ganciclovir, gentami- cin, glycopyrrolate, hydrOXYzine, imipe- nem-cilastatin, inamrinone, iohexol, iopamidol, iothalamate, isoproterenol, labetalol, lidocaine, magnesium, mannitol, meperidine, metaraminol, methoxamine, methyldopate, metoclopramide, metopro- lol, miconazole, midazolam, minocycline, morphine, multiple vitamins, nalbuphine, naloxone, netilmicin, nitroglycerin, nitro- prusside, norepinephrine, ondansetron, oxytocin, papaverine, pentazocine, phenyl- ephrine, polymyxin B, potassium chloride, procainamide, prochlorperazine, prometh- azine, propranolol, pyridoxine, quiNIDine, raNITIdine, Ringer’s, ritodrine, sodium bicarbonate, succinylcholine, SUFentanil, theophylline, thiamine, tobramycin, tolazo- line, trimetaphan, urokinase, vancomycin, vasopressin, verapamil
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Assess: • Bleeding: 30 min to 18 hr after dose in cardiac surgery
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Evaluate: • Therapeutic response: reversal of hep- arin overdose
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Not to take if allergic to fish • The purpose of product, expected re- sult • To avoid activities in which bleeding may occur—shaving, use of hard-bris- tle toothbrush, injections, rectal tem- perature—until risk for bleeding has passed
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PHARMACOKINETICS IV: Onset 5 min, duration 2 hr, half-life unknown
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• Adult/child: IV 1 mg of protamine/100 units heparin given; administer slowly over 1-3 min; max 50 mg/10 min Enoxaparin overdose
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• Adult: IV 1 mg protamine/1 mg enoxa- parin Dalteparin overdose
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• Adult: IV 1 mg protamine/100 anti-Xa unit
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