lHEPATIC IMPAIRMENT
Dose adjustmentsCarefully titrate dose.
lDIRECTIONS FOR ADMINISTRATIONForcontinuous
intravenous infusion, dilute with Glucose 5 % or Sodium
Chloride 0. 9 %.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Flumazenil (Non-proprietary)
Flumazenil 100 microgram per 1 mlFlumazenil
500 micrograms/ 5 ml solution for injection ampoules|
5 ampouleP£ 65. 50 – £ 70. 00
3.2 Digoxin toxicity
ANTIDOTES AND CHELATORS›ANTIBODIES
Digoxin-specific antibody
lINDICATIONS AND DOSE
Treatment of known or strongly suspected life-
threatening digoxin toxicity associated with ventricular
arrhythmias or bradyarrhythmias unresponsive to
atropine and when measures beyond the withdrawal of
digoxin and correction of any electrolyte abnormalities
are considered necessary
▶BY INTRAVENOUS INFUSION
▶Child:Serious cases of digoxin toxicity should be
discussed with the National Poisons Information
Service (consult product literature)lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder for solution for infusion
▶DigiFab(BTG International Ltd)
Digoxin-specific antibody fragments 40 mgDigiFab 40 mg powder
for solution for infusion vials| 1 vialP£ 750. 00 (Hospital only)
3.3 Heparin toxicity
ANTIDOTES AND CHELATORS
Protamine sulfate
lINDICATIONS AND DOSE
Overdosage with intravenous injection or intravenous
infusion of unfractionated heparin (less than 30 minutes
lapsed since overdose)
▶BY INTRAVENOUS INJECTION
▶Child: 1 mg (max. per dose 50 mg), to be administered
at a rate not exceeding 5 mg/minute, to neutralise each
100 units of unfractionated heparin
Overdosage with intravenous injection or intravenous
infusion of unfractionated heparin (if 30 – 60 minutes
lapsed since overdose)
▶BY INTRAVENOUS INJECTION
▶Child: 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 unfractionated heparin
Overdosage with intravenous injection or intravenous
infusion of unfractionated heparin (if 60 – 120 minutes
lapsed since overdose)
▶BY INTRAVENOUS INJECTION
▶Child: 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 unfractionated heparinOverdosage with intravenous injection or intravenous
infusion of unfractionated heparin (if over 120 minutes
lapsed since overdose)
▶BY INTRAVENOUS INJECTION
▶Child: 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 unfractionated heparin
Overdosage with subcutaneous injection of
unfractionated heparin
▶BY INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION
▶Child:(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 unfractionated heparin
Overdosage with subcutaneous injection of low molecular
weight heparin
▶BY INTRAVENOUS INJECTION, OR BY CONTINUOUS
INTRAVENOUS INFUSION
▶Child:(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 detailslCAUTIONSExcessive doses can have an anticoagulant
effect
lSIDE-EFFECTS
▶Rare or very rareHypertension.pulmonary oedema non-
cardiogenic
▶Frequency not knownAcute pulmonary vasoconstriction.
back pain.bradycardia.circulatory collapse.dyspnoea.
fatigue.feeling hot.flushing.nausea.pulmonary
hypertension.vomiting
lALLERGY AND CROSS-SENSITIVITYCaution if increased risk
of allergic reaction to protamine (includes previous
treatment with protamine or protamine insulin, allergy to
fish, men who are infertile or who have had a vasectomy
and who may have antibodies to protamine).
lMONITORING REQUIREMENTSMonitor activated partial
thromboplastin time or other appropriate blood clotting
parameters.
lDIRECTIONS FOR ADMINISTRATIONMay be diluted if
necessary with Sodium Chloride 0. 9 %.
lPRESCRIBING AND DISPENSING INFORMATIONThe long
half-life of low molecular weight heparins should be taken
into consideration when determining the dose of
protamine sulfate; the effects of low molecular weight
heparins can persist for up to 24 hours after
administration.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Protamine sulfate (Non-proprietary)
Protamine sulfate 10 mg per 1 mlProtamine sulfate 100 mg/ 10 ml
solution for injection ampoules| 5 ampoulePs
Protamine sulfate 50 mg/ 5 ml solution for injection ampoules|
10 ampouleP£ 49. 55BNFC 2018 – 2019 Heparin toxicity 841
Emergency treatment of poisoning16