Pharmacology. Protamine is a cationic protein obtained from fish sperm that rapidly binds to and inactivates heparin. The onset of action after intravenous administration is nearly immediate (30–60 seconds) and lasts up to 2 hours. It also partially neutralizes low-molecular-weight heparins (LMWHs) and can act as an anticoagulant by inhibiting thromboplastin.

Indications

1. 
   

   Protamine is used for the reversal of the anticoagulant effect of heparin when an excessively large dose has been administered inadvertently. Protamine generally is not needed for the treatment of bleeding during standard heparin therapy because discontinuance of the heparin infusion is generally sufficient.

   
   
2. 
   

   Protamine may be used for the reversal of regional anticoagulation in the hemodialysis circuit in cases in which anticoagulation of the patient is contraindicated (ie, active GI or CNS bleeding).

Contraindications

1. 
   

   Do not give protamine to patients with known sensitivity to the drug. Patients with diabetes who have used protamine insulin may be at the greatest risk for hypersensitivity reactions.

   
   
2. 
   

   Protamine reconstituted with benzyl alcohol should not be used in neonates because of suspected toxicity from the alcohol.

Adverse effects

1. 
   

   Rapid intravenous administration is associated with hypotension, bradycardia, and anaphylactoid reactions. Have epinephrine (See Epinephrine

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