Drug Index

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 :

  • Heparin antidote

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)
20-50Dose as in normal renal function
10-20Dose as in normal renal function
<10Dose as in normal renal function

Dose in Patients undergoing Renal Replacement Therapies
CAPDUnknown dialysability. Dose as in normal renal function
HDUnknown dialysability. Dose as in normal renal function
HDF/High fluxUnknown dialysability. Dose as in normal renal function
CAV/VVHDUnknown dialysability. Dose as in normal renal function

Hepatic Dose :

No dosage adjustments are recommended.
03/24/2024 11:03:09 Protamine Sulphate
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