Protamine sulfate

What is Protamine sulfate

Protamine sulfate, a protein derived from fish sperm, is a chemical antagonist of heparin.

Clinically, protamine is indicated for heparin overdose and is commonly used to neutralize heparin during extracorporeal circulation following dialysis, and arterial or cardiac surgery.

Dosage is guided by blood coagulation studies, with each mg of protamine sulfate neutralizing not less than 100 USP heparin units. Protamine must be administered via slow intravenous injection at a rate not to exceed 50 mg over a 10 minute period.

High doses and rapid administration may result in severe hypotension, cardiovascular collapse, pulmonary edema, pulmonary vasoconstriction, and pulmonary hypertension.

Indications

  • cardiac surgery
  • hemorrhage
  • heparin toxicity

For the treatment of low-molecular weight heparin (LMWH) or unfractionated heparin toxicity, or for hemorrhage associated with unfractionated heparin (UFH) or LMWH therapy

for UFH toxicity or hemorrhage associated with UFH therapy

Side Effects

  1. anaphylactic shock
  2. angioedema
  3. back pain
  4. bleeding
  5. bradycardia
  6. bronchospasm
  7. dyspnea
  8. fatigue
  9. flushing
  10. heart failure
  11. hypotension
  12. pulmonary edema
  13. pulmonary hypertension
  14. rash
  15. serious hypersensitivity reactions or anaphylaxis
  16. urticaria
  17. wheezing

Monitoring Parameters

  • partial thromboplastin time (PTT)

Contraindications

  • breast-feeding
  • fish hypersensitivity
  • pregnancy
  • requires a specialized care setting
  • serious hypersensitivity reactions or anaphylaxis
  • ventricular dysfunction

Interactions

  • Heparin

Heparin: (Severe) Upon contact with heparin, protamine forms a salt, neutralizing the anticoagulant effect of both drugs. Protamine, a strongly basic compound, forms complexes with heparin sodium or heparin calcium, which are acidic compounds. Formation of this complex can result in disruption of the heparin-antithrombin III complex responsible for the anticoagulant activity of heparin. Protamine is used therapeutically to reverse the activity of heparins.

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