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.
- 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.
- 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.
- 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 hemodynamics 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.
- Hypotension and histamine release and Anaphylaxis