Protamine Sulphate Injection

What is Protamine Sulphate Injection?
Protamine Sulphate Injection is a critical heparin antagonist and an essential reversal agent in cardiovascular medicine. It is a highly basic protein, originally derived from the sperm of salmon and other fish, that acts as a specific antidote to heparin. It is a "must-have" medication in operating rooms and cardiac catheterization labs, where it is used to rapidly restore normal blood clotting after procedures involving systemic anticoagulation.
Uses of Protamine Sulphate Injection
Neutralization of Heparin: Reverses the blood-thinning effects of heparin following major surgeries.
Cardiac Surgery: Used post-cardiopulmonary bypass to restore normal coagulation before closing.
Vascular Surgery: To neutralize heparin after arterial grafting or other vascular repairs.
Hemodialysis: To reverse heparinization at the end of a dialysis session if required.
Heparin Overdose: Emergency management of accidental or intentional heparin overdosage leading to hemorrhage.
How Does Protamine Sulphate Injection Work?
Protamine Sulphate works through a neutralization reaction. Because it is strongly basic (positively charged), it binds ionically to the strongly acidic (negatively charged) heparin molecule. This creates a stable, inactive salt complex that has no anticoagulant activity. This reaction happens almost instantly, effectively "trapping" the heparin and allowing the body's natural clotting mechanisms to take over again.
FAQs on Protamine Sulphate Injection
1. How much Protamine is needed to reverse Heparin? Generally, 1 mg of Protamine Sulphate neutralizes approximately 100 units of Heparin. However, because heparin is cleared from the body over time, the required dose of Protamine decreases as time passes since the last heparin administration.
2. Can Protamine Sulphate be given quickly? No. It must be administered by very slow intravenous injection (e.g., 50 mg over 10 minutes). Rapid injection can cause severe side effects, including a sudden drop in blood pressure (hypotension), bradycardia, and pulmonary hypertension.
3. Are there allergy risks associated with Protamine? Yes. Since it is derived from fish sources, patients with fish allergies are at a higher risk of hypersensitivity reactions. Additionally, individuals who have used protamine-containing insulin (like NPH insulin) or have had a vasectomy may have pre-existing antibodies and should be monitored closely.
Therapeutic Category
Cardiovascular (Antidote / Heparin Antagonist)
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