Makindo Medical Notes.com

Protamine is specifically used in Heparin overdose, in low molecular weight Heparin overdose, and to reverse the effects of Heparin during delivery and heart surgery.

About: Always check the BNF link here

• The active substance protamine sulphate is a purified mixture of simple proteins obtained from the sperm of a species of wild salmon fished off the coast of Japan (a specific area off the coast of Honshu).

Mode of action

• Protamine is a positively charged protein molecule, binds the negatively charged Heparin, and this complex is removed from the circulation by the reticuloendothelial system.

Indications/Dose

• Reverse effect of LMWH and UFH: Protamine 1 mg for every 80-100 U of UFH S/C or IV
• Give Protamine 25-50 mg IV infusion at 5 mg/min. Max 50 mg.

Interactions

• See BNF

Cautions

• Protamine sulfate can cause severe hypotension, cardiovascular collapse, noncardiogenic pulmonary oedema, catastrophic pulmonary vasoconstriction, and pulmonary hypertension.
• Risk factors include high dose or overdose, rapid administration, repeated doses, previous administration of protamine, 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 haemodynamics also may be risk factors.
• In patients with any of these risk factors, the risk to benefit of administration of protamine sulfate should be carefully considered.
• Vasopressors and resuscitation equipment should be immediately available in case of a severe reaction to protamine.
• Protamine sulfate should not be given when bleeding occurs without prior Heparin use.

Contraindications

• See BNF

Side effects

• Hypotension and histamine release and Anaphylaxis

References

• Protamine BNF