II. Indications
- Heparin Reversal
- Low Molecular Weight Heparin (LMWH) partial reversal
III. Mechanism
- Binds and neutralizes Heparin and partially binds and neutralizes Low Molecular Weight Heparin (LMWH)
IV. Dosing: Heparin Reversal (FDA Approved)
V. Dosing: Low Molecular Weight Heparin (LMWH) partial reversal (off-label use)
- Last LMWH dose in last 8 hours
- Protamine 1 mg per 100 anti-Xa units Dalteparin
- Protamine 1 mg per 1 mg Enoxaparin
- Last LMWH dose longer than 8 hours ago
- Protamine 0.5 mg per 100 anti-Xa units Dalteparin
- Protamine 0.5 mg per 1 mg Enoxaparin
- Additional dose if PTT still prolonged at 2-4 hours after Protamine infusion
- Protamine 0.5 mg per 100 anti-Xa units Dalteparin
- Protamine 0.5 mg per 1 mg Enoxaparin
VI. Adverse Effects
- Anaphylactoid Reaction with rapid administration (especially with fish allergy history)
- Pulmonary Edema
- Hypotension to the point of cardiovascular collapse
VII. Resources
VIII. References
- (2010) Tarascon Pharmacopoeia
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| Definition (MSH) | A group of simple proteins that yield basic amino acids on hydrolysis and that occur combined with nucleic acid in the sperm of fish. Protamines contain very few kinds of amino acids. Protamine sulfate combines with heparin to form a stable inactive complex; it is used to neutralize the anticoagulant action of heparin in the treatment of heparin overdose. (From Merck Index, 11th ed; Martindale, The Extra Pharmacopoeia, 30th ed, p692) |
| Definition (CSP) | group of small (30-50 residues), arginine-rich nucleoproteins found sporadically throughout the phylogenetic kingdom; the USP drug, the sulfate salt, is used as an antidote to heparin. |
| Concepts | Biologically Active Substance (T123) , Amino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121) |
| MSH | D011479 |
| SnomedCT | 350083007, 372630008 |
| LNC | LP15134-7 |
| English | Protamines, protamine, Protamines [Chemical/Ingredient], PROTAMINE, Protamine, Protamine (product), Protamine (substance) |
| Swedish | Protaminer |
| Czech | protaminy |
| Finnish | Protamiinit |
| Russian | PROTAMINA SUL'FAT, PROTAMINY, ПРОТАМИНЫ, ПРОТАМИНА СУЛЬФАТ |
| Japanese | プロタミン, 硫酸プロタミン |
| Polish | Protaminy |
| Spanish | protamina (producto), protamina (sustancia), protamina, Protaminas |
| French | Protamine |
| German | Protamine |
| Italian | Protamine |
| Portuguese | Protaminas |
