protamine
Protamine is an anticoagulant reversal agent that helps to stop bleeding caused by heparin. Protamine is typically given in a hospital setting as an intravenous (IV) injection over 10 minutes. And it begins to work within 5 minutes. Side effects include low blood pressure and slow heart rate, so your provider will keep an eye on these to make sure they don't drop too low.
What is Protamine?
What is Protamine used for?
- To treat bleeding caused by heparin
How Protamine works
Protamine is an anticoagulant reversal agent. It works by attaching to heparin and preventing it from making your blood thinner. This way, it stops any bleeding that might be happening.
Drug facts
Side effects of Protamine
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Low blood pressure
- Slow heart rate
Less Common Side Effects
- Back pain
- Shortness of breath
- Nausea
- Vomiting
- Flushing
- Lacking energy
Protamine serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious allergic reaction: difficulty breathing, tightness in the throat, hives, fast heartbeat, dizziness, lightheadedness, swelling in the face or tongue
The following Protamine side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds, red or dark brown urine, small red or purple spots on skin, unusual bruising or bleeding
- Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
- Pulmonary hypertension—shortness of breath, chest pain, fast or irregular heartbeat, feeling faint or lightheaded, fatigue, swelling of the ankles or feet
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Flushing
- Nausea
- Vomiting
Pros and cons of Protamine
Pros
- Works quickly to reverse the effects of heparin
- Given as an IV injection over 10 minutes
Cons
- Needs to be given in a healthcare setting
- Can suddenly lower blood pressure and heart rate
Pharmacist tips for Protamine
- Your provider will order blood tests (e.g., complete blood count) and examine you for signs and symptoms of bleeding after receiving protamine to see how well you respond to the medication.
- Make sure to let your provider know if you are taking a blood thinner at home. They'll decide if and when you should restart it after receiving protamine.
Common questions about Protamine
Protamine starts to work within 5 minutes and can last for up to 2 hours.
Protamine and vitamin K (phytonadione) are two completely different medications. They're both used to stop bleeding of blood thinners, but protamine is used to treat a heparin overdose while vitamin K (phytonadione) is used to treat a warfarin (Coumadin) overdose.
People who've had a past reaction to protamine are more likely to develop another allergic reaction to the medication. Also, those who have a fish allergy could also be at higher risk for an allergic reaction to protamine because it comes from salmon sperm.
Yes, a sudden drop in blood pressure and heart rate are possible side effects of protamine. This is thought to happen because protamine releases a chemical that causes your blood vessels to widen. Your provider will likely monitor your blood pressure and heart rate before and after receiving protamine to make sure it doesn't get too low.
It can. While protamine isn't FDA approved to stop bleeding caused by an excess of enoxaparin (Lovenox), too much enoxaparin (Lovenox), some providers use it off-label because it works to some degree. The dose depends on when enoxaparin (Lovenox) was given, but in general, it's 0.5 to 1 mg of protamine per 1 mg of enoxaparin (Lovenox).
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Risks and warnings for Protamine
Protamine can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Severe heart problems
- Risk factors: Rapid administration of protamine | High dose of protamine | Repeated doses of protamine | Using other medications that also contain protamine
Although rare, protamine can cause severe heart problems, including low blood pressure, slow heart rate, sudden collapse, and fluid overload in the lungs. Your provider will monitor your vitals closely before, during, and after you receive protamine and provide treatment if needed.
Serious allergic reactions
Serious allergic reactions to protamine are possible, including life-threatening reactions like anaphylaxis (e.g., closing of the throat). Your provider will monitor you for symptoms like dizziness, nausea, a choking sensation, difficulty breathing, swelling around your eyes, or swelling of the lips or tongue while you're receiving protamine.
Protamine dosage
Typical dosage for Protamine
Your provider will help determine your dose. The typical dose depends on the amount of heparin you receive. Each 1 mg of protamine is given for about every 100 units of heparin. The maximum dose is 50 mg.
Protamine images
