Usual Adult Dose for Heparin Overdose

Protamine sulfate 1 mg IV neutralizes approximately 90 units of heparin activity derived from lung tissue or about 115 units derived from intestinal mucosa. Do not exceed 50 mg per dose.

Usual Geriatric Dose for Heparin Overdose

Protamine sulfate 1 mg IV neutralizes approximately 90 units of heparin activity derived from lung tissue or about 115 units derived from intestinal mucosa. Do not exceed 50 mg per dose.

Usual Pediatric Dose for Heparin Overdose

Protamine sulfate 1 mg IV neutralizes approximately 90 units of heparin activity derived from lung tissue or about 115 units derived from intestinal mucosa. Do not exceed 50 mg per dose.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

Since blood heparin concentrations decrease rapidly after heparin administration, adjust the protamine dosage depending upon the duration of time since heparin administration as follows:

If < 30 minutes since last heparin dose: 1 mg of protamine will neutralize 100 units of heparin.
If 30 to 60 minutes since last heparin dose: 0.5 to 0.75 mg of protamine will neutralize 100 units of heparin.
If 60 to 120 minutes since last heparin dose: 0.375 to 0.5 mg of protamine will neutralize 100 units of heparin.
If > 120 minutes since last heparin dose: 0.25 to 0.375 mg of protamine will neutralize 100 units of heparin.

If heparin is administered by deep subcutaneous injection, use 1 to 1.5 mg of protamine per 100 units of heparin. This may be done by administering a portion of the dose slowly IV, followed by the remaining portion as a continuous infusion over 8 to 16 hours.

Precautions

US BOXED WARNING:

• HYPERSENSITIVITY REACTIONS: This drug can cause severe hypotension, cardiovascular collapse, noncardiogenic pulmonary edema, catastrophic pulmonary vasoconstriction, and pulmonary hypertension. Risk factors include high dose or overdose, rapid administration, repeated doses, previous administration of this drug, and current or previous use of protamine-containing drugs (NPH insulin, protamine zinc insulin, and certain beta-blockers). Allergy to fish, previous vasectomy, and severe left ventricular dysfunction and abnormal preoperative pulmonary hemodynamics also may be risk factors. In patients with any of these risk factors, the risk to benefit of administration of this drug should be carefully considered. Vasopressors and resuscitation equipment should be immediately available in case of a severe reaction to protamine. This drug should not be given when bleeding occurs without prior heparin use.

Dialysis

Data not available

Other Comments

The dose should not exceed 50 mg, and should be administered via slow IV (over 10 minutes) push.