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Protamine sulfate

- Discussion: 
- Reversal of Heparin effect; binds heparin within 5min of IV infusions (give slowly as 2mg/ml solution in saline); 
- Monitor PTT for effects; 
- Protamine sulfate itself has anticoagulant properties, hence judge needed amount conservatively; 
- Precautions: 
- hypotension may result from rapid infusion;

- watch for anaphylactoid like reactions; 
- Dose: 
- based on amount of heparin reversal desired;

- given slowly IV, 1 mg will reverse approx 100 units of heparin given in over 3-4hr to max dose of 50 mg in any 10 min period, or 200 mg w/ in 2hrs; 
- no more than 100 mg should be given except in extreme circumstances