Protamine sulfate is a medication that is used to reverse the effects
of heparin. It is specifically used in heparin overdose, in low
molecular weight heparin overdose, and to reverse the effects of
heparin during delivery. It is given by injection into a vein.
The onset of effects is typically within five minutes.
Common side effects include low blood pressure, slow heart rate,
allergic reactions, and vomiting.
1 Medical uses
2 Adverse effects 3 Mechanism 4 History 5 References 6 External links
Medical uses Protamine sulfate is usually administered to reverse the large dose of heparin administered during certain surgeries, especially heart surgery. A dose of protamine is given when the patient is off - pump, when extracorporeal circulation and anticoagulation are no longer needed. It is also used in gene transfer, protein purification and in tissue cultures as a crosslinker for viral transduction. In gene therapy, protamine sulfate has been studied as a means to increase transduction rates by both viral and nonviral (e.g. utilizing cationic lipids) mediated delivery mechanisms. Dosage Dosage for heparin reversal is 1.0 -to- 1.5 mg protamine sulfate IV for every 100 IU of active heparin. PTT should be monitored at 5–15 minutes after dose then in 2–8 hours afterward. Adverse effects Protamine has been reported to cause allergic reactions in patients who are allergic to fish, diabetics using insulin preparations containing protamine, and vasectomized or infertile men. These occur at rates ranging from 0.28% to 6%. Avoiding rapid infusion of protamine sulfate and pre-treating at-risk patients with histamine receptor antagonists (H1 and H2) and steroids may minimize these reactions. A 5–10 mg test dose is recommended following pretreatment before administering the full dose. Mechanism It is a highly cationic peptide that binds to either heparin or low molecular weight heparin (LMWH) to form a stable ion pair, which does not have anticoagulant activity. The ionic complex is then removed and broken down by the reticuloendothelial system. In large doses, protamine sulfate may also have an independent—however weak—anticoagulant effect. History Protamine was originally isolated from the sperm of salmon and other species of fish but is now produced primarily through recombinant biotechnology. References
^ a b "Prosulf 10mg/ml Solution for Injection - Summary of Product
Characteristics (SPC) - (eMC)". www.medicines.org.uk. Archived from
the original on 20 December 2016. Retrieved 14 December 2016.
^ a b c d e f g h "
Protamine Sulfate". The American Society of
Health-System Pharmacists. Archived from the original on 6 November
2016. Retrieved 8 December 2016.
^ WHO Model Formulary 2008 (PDF). World Health Organization. 2009.
p. 255. ISBN 9789241547659. Archived (PDF) from the original
on 13 December 2016. Retrieved 8 December 2016.
Protamine Use During Pregnancy Drugs.com". www.drugs.com.
Archived from the original on 21 December 2016. Retrieved 14 December
WHO Model List of Essential Medicines
Protamine Sulfate at the US National Library of Medicine Medical Subject Headings (MeSH)
v t e
intrinsic: IX/Nonacog alfa VIII/Moroctocog alfa/Turoctocog alfa
extrinsic: VII/Eptacog alfa
common: X II/Thrombin I/Fibrinogen XIII/Catridecacog
Prothrombin complex concentrate
Etamsylate Carbazochrome Batroxobin thrombopoietin receptor agonist (Romiplostim Eltrombopag Lusutrombopag)
Absorbable gelatin sponge Oxidized cellulose Tetragalacturonic acid hydroxymethylester Thrombin Collagen Calcium alginate Epinephrine/Adrenalone
amino acids (Aminocaproic acid Tranexamic acid Aminomethylbenzoic acid) serpins (Aprotinin Alfa1 antitrypsin C1-inhibitor Camostat)
v t e
Atropine# Biperiden Diazepam# Oximes
see also: Cholinesterase
Diprenorphine Doxapram Nalmefene Nalorphine Naloxone# Naltrexone
Reversal of neuromuscular blockade
Digoxin Immune Fab
4-Dimethylaminophenol Hydroxocobalamin nitrite
Amyl nitrite Sodium nitrite#
Primary alcohols: Ethanol Fomepizole
Paracetamol toxicity (Acetaminophen)
Acetylcysteine# Glutathione Methionine#
Toxic metals (cadmium
lead mercury thallium)
Dimercaprol# Edetates Prussian blue#
Methylthioninium chloride# oxidizing agent
Copper sulfate Ipecacuanha
Syrup of ipecac
#WHO-EM ‡Withdrawn from market Clinical trials:
†Phase III §Never to phase III
Pharmacy and pharmacology portal Med