Protamin Sulphate

Indications

Protamin Sulphate is used for: Heparin overdosage, Heparin neutralisation, Enoxaparin or dalteparin overdosage

Adult Dose

Intravenous Heparin overdosage Adult: Dosage depends on administered heparin dose, its route of admin, time elapsed since heparin admin, and blood coagulation studies. For heparin administered via IV inj: If only a few min have elapsed since admin, 1 mg for every 100 U of heparin administered; if 30-60 min have elapsed since admin, 0.5-0.75 mg for every 100 U of heparin; and if >2 hr have elapsed since admin, 0.25-0.375 mg for every 100 U of heparin. Doses to be given via inj at <5 mg/min. Max: 50 mg/dose. For heparin administered via IV infusion: 25-50 mg via inj after stopping heparin infusion. For heparin administered via SC inj: 1-1.5 mg via IV inj for each 100 U of heparin administered. Alternatively, loading dose of 25-50 mg via slow IV inj and the rest of the dose via continuous IV infusion over 8-16 hr or the expected duration of absorption of heparin. Enoxaparin or dalteparin overdosage Adult: Dose depends on the administered dose of the LMWH, time elapsed since drug was administered and blood coagulation tests. For enoxaparin: If ?8 hr since admin, 1 mg for every 1 mg of enoxaparin administered; if >8 hr has elapsed since admin, infuse 0.5 mg for every 1 mg of enoxaparin administered. For dalteparin: 1 mg for every 100 anti-Xa U of dalteparin administered. If aPTT remains prolonged 2-4 hr after the 1st infusion, a 2nd infusion may be given.

Child Dose

Renal Dose

Administration

Contra Indications

Hypersensitivity.

Precautions

Patient at risk of developing hypersensitivity to protamine (e.g. previous history of procedures such as coronary angioplasty or cardiopulmonary bypass surgery where protamine is frequently used, diabetics using protamine insulin, allergy to fish, vasectomised or infertile males who may have antibodies to protamine). Pregnancy and lactation. Monitoring Parameters Monitor clotting parameters closely esp in prolonged procedures. Monitor aPTT or activated coagulation time, 5-15 min after protamine sulfate admin.

Pregnancy-Lactation

Interactions

Adverse Effects

Side effects of Protamin Sulphate : Hypotension, bradycardia, pulmonary and systemic hypertension, dyspnoea, warm sensation, transitory flushing, nausea and vomiting, lassitude. Potentially Fatal: Severe hypersensitivity reactions e.g. CV collapse, fatal anaphylactic reaction; noncardiogenic pulmonary oedema with prolonged hypotension (rare).

Mechanism of Action

Protamine sulfate, prepared from the sperm or mature testes of salmon or related species, is a heparin antagonist. It combines with heparin to form a stable inactive complex. Protamine sulfate is often used in the treatment of bleeding from severe heparin overdose and should not be used in minor overdose/bleeding as heparin withdrawal will usually correct itself within a few hr. For LMWH, protamine sulfate neutralises the anti-thrombin activity but only partly neutralises the anti-factor-Xa effect. When admin in the absence of heparin, protamine sulfate has an anticoagulant effect. Protamine is not useful for reversing the effects of oral anticoagulants.