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protamine

V03AB14

Forms & Strengths

Injectable protamine sulfate solution 10 mg/mL
Lyophilized powder for reconstitution 25 mg vial

Adult Dosing

IV bolus 1 mg per 100 IU unfractionated heparin; max 50 mg
LMWH (enoxaparin) 1 mg protamine per 1 mg enoxaparin IV
Heparin lock reversal 25–50 mg IV over 10 min
If used for protamine‑induced hypotension 0.5 mg IV slowly

Pediatric Dosing

IV 0.5–1 mg per 100 IU heparin; dose weight‑based, max 10 mg
LMWH reversal 1 mg protamine per 1 mg enoxaparin IV
Neonates/infants 0.5 mg/kg IV slowly

Indications

Reversal of unfractionated heparin anticoagulation
Neutralization of low‑molecular‑weight heparin overdose
Reversal of heparin during cardiac surgery or catheterization
Treatment of protamine‑induced hypotension
Neutralization of heparin in dialysis circuits

Mechanism of Action

Positively charged protein binds anionic heparin forming a stable inactive complex
Neutralizes heparin‑mediated antithrombin activation
Rapidly reduces circulating heparin activity

Contraindications

Known hypersensitivity to protamine or fish products
Previous severe anaphylactic reaction to protamine
Severe coronary artery disease (risk of profound hypotension)

Adverse Reactions

Hypotension, especially with rapid IV administration
Bradycardia or tachycardia
Pulmonary hypertension
Anaphylaxis, urticaria, flushing
Nausea, vomiting, metallic taste
Chest pain, myocardial ischemia
Thrombocytopenia

Drug Interactions

Concurrent vasodilators (e.g., nitroglycerin) may exacerbate hypotension
Beta‑blockers may blunt compensatory tachycardia
Protamine can delay insulin absorption → hyperglycemia
Heparin: protamine neutralizes anticoagulant effect dose‑dependently
LMWH: partial neutralization; dose adjustment may be required
Direct thrombin inhibitors (e.g., dabigatran) not neutralized

Curated Content: Needs Vetting Before Put to Clinical Use