Protamine Sulphate
Mechanism :
Protamines are simple proteins of low molecular weight that are rich in arginine and strongly basic. They occur in the sperm of salmon and certain other species of fish. It acts as a heparin antagonist. It is also a weak anticoagulant.
Indication :
Contraindications :
Patients who have shown previous intolerance to the drug.
Dosing :
1 mg for each 100 units low molecular weight
heparin (LMWH) or 80 units for bovine
heparin given at last dose. Maximum dose 50 mg. Administer within 15 minutes-if the delay is longer, less
protamine is required, as
heparin is rapidly excreted (after 30 minutes give approximately half dose). If less than 30 minutes since last dose: 1 mg/100U IV, 30-60 min: 0.5-0.75 mg/100 U IV, >120 min: 0.25-0.375 mg/100U IV. Max rate: <5 mg/min.
Adverse Effect :
Sudden fall in blood pressure, bradycardia, pulmonary hypertension, dyspnea, or transitory flushing and a feeling of warmth. Anaphylaxis, systemic hypertension, nausea, vomiting, lassitude.
Interaction :
Cephalosporins and Penicillins: Protamine has been shown to be incompatible with certain antibiotics, including several of the cephalosporins and penicillins.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unknown dialysability. Dose as in normal renal function |
| HD | Unknown dialysability. Dose as in normal renal function |
| HDF/High flux | Unknown dialysability. Dose as in normal renal function |
| CAV/VVHD | Unknown dialysability. Dose as in normal renal function |
Hepatic Dose :
No dosage adjustments are recommended.