![]() Avoid or Use Alternate Drug.Ĭonjugated estrogens decreases effects of protamine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.Ĭlarithromycin increases effects of protamine by decreasing metabolism. Avoid or Use Alternate Drug.Ĭefamandole increases effects of protamine by pharmacodynamic synergism. Avoid or Use Alternate Drug.īutalbital decreases effects of protamine by increasing metabolism. Avoid or Use Alternate Drug.īutabarbital decreases effects of protamine by increasing metabolism. Avoid or Use Alternate Drug.īivalirudin and protamine both increase anticoagulation. Risk of thromboembolic disorders.īemiparin and protamine both increase anticoagulation. Avoid or Use Alternate Drug.īazedoxifene/conjugated estrogens decreases effects of protamine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.Īzithromycin increases effects of protamine by decreasing metabolism. Avoid or Use Alternate Drug.Īrgatroban and protamine both increase anticoagulation. Avoid or Use Alternate Drug.Īntithrombin III and protamine both increase anticoagulation. Avoid or Use Alternate Drug.Īntithrombin alfa and protamine both increase anticoagulation. Avoid or Use Alternate Drug.Īmobarbital decreases effects of protamine by increasing metabolism. Enhanced risk of hemorrhage.Īllopurinol increases effects of protamine by decreasing metabolism. ![]() on anticoagulant therapy.Įither increases effects of the other by pharmacodynamic synergism. Contraindicated.Ĭomment: Mifepristone may lead to excessive post abortion bleeding in pts. In setting without bleeding complications, consider observation, rather than reversal of anticoagulation with protamine (avoids ADR's)Ĭomplex of protamine and heparin may degrade over time requiring further doses Dalteparin or Tinzaparin Overdoseġ mg protamine for 100 units dalteparin or tinzaparin if PTT prolonged 4hr after protamine overdose administer 0.5 mg per 100 units of dalteparin or tinzaparin Enoxaparin Overdoseġ mg per mg enoxaparin (if enoxaparin overdose given within 8 hr) if >8 hr of overdose or bleeding continues after 4 hr after first dose, give 0.5 mg protamine per mg enoxaparin Time Elapsed Since Heparin Dose Dose of protamine (mg) to neutralize 100 units of heparin In accidental overdoses of heparin, consider t1/2 heparin 60-90 min Monitor APTT 5-15 min after dose then in 2-8 hr 1-1.5 mg per 100 USP units of heparin not to exceed 50 mg
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