What is a medicinal substance like protamine sulfate? Instructions for its use, as well as the form and indications of this tool will be indicated below.
Composition, description, form
What is protamine sulfate? It is a solution produced in the form of a yellowish or colorless transparent liquid, intended for intravenous administration. The drug based on this medicinal substance has the same name and additionally contains water for injection.
Protamine sulfate goes on sale in ampoules, which are placed in contour cells made of polyvinyl chloride film, which are packaged in cardboard boxes. The package also contains instructions for use and an ampoule knife.
Drug action
What is protamine sulfate? The instruction says that it is a heparin antagonist (specific). 1 mg of this substance is able to neutralize about 80-115 units of heparin in the patient's blood.
The action of the agent under consideration after intravenous injection occurs instantly and lasts about two hours. The complex formation of this drug is due to the abundance of cationic groups that bind to anionicheparin centers.
According to the instructions, protamine sulfate in the human body forms a protamine-heparin complex, which is destroyed with the release of the latter.
In case of an overdose of this agent, the patient's blood clotting may significantly decrease, since the active substance of the drug in question exhibits high anticoagulant activity.
Pharmacokinetics of the drug
What are the kinetic properties of heparin protamine sulfate? According to experts, the pharmacokinetic characteristics of this medicinal substance have not been studied. Therefore, they are not presented in the instructions.
Indications for the appointment of the solution
In what cases can a patient be prescribed an intravenous solution of "Protamine sulfate"? The use of this remedy is shown:
- before surgery in people taking heparin for therapeutic purposes;
- with hyperheparinemia;
- for bleeding due to heparin overdose;
- after surgery on blood vessels and heart with extracorporeal circulation.
Prohibitions on prescribing solution
The drug "Protamine sulfate" (only a doctor should write a prescription for its purchase) is contraindicated for use in the following cases:
- thrombocytopenia;
- high sensitivity to drug elements;
- severe arterial hypotension;
- congenital oridiopathic hyperheparinemia (in this condition, the medication is ineffective, and can also significantly increase bleeding);
- taking insulin and other medicines containing protamine sulfate;
- allergic reactions to fish products, including history;
- adrenal cortex insufficiency.
Not to mention that there is limited medical experience with this remedy in children.
During pregnancy and feeding "Protamine sulfate" can be used. However, this should only be done if the expected effect of treatment significantly outweighs the likely risk to the fetus or child.
Protamine sulfate preparation: instructions for use
The solution in question should be administered slowly intravenously by drip or jet. In this case, the rate of administration should not be higher than 5 mg of the drug per minute. A more rapid administration of the drug may cause an anaphylactoid reaction in the patient.
The dosage of this medication depends on how it is administered. The calculated dose should be dissolved in 300-500 ml of 0.9% sodium chloride solution. It is strictly forbidden to inject more than 150 mg of the drug within 60 minutes.
- With bolus injections, the dosage of protamine sulfate is reduced depending on the time that has elapsed from the introduction of heparin. This is due to the fact that the latter is continuously removed from the human body.
- If heparin is administered intravenously, then it is necessarystop his infusion and use about 20-30mg protamine sulfate.
- When heparin is injected subcutaneously, the dosage of protamine sulfate is 1-1.5 mg per 100 IU of heparin. In this case, the first 25-50 mg must be administered slowly intravenously, and the remaining amount - drip intravenously over 8-17 hours. Fractional administration is also possible, but this will require strict control of the APTT.
- During surgery in the case of extracorporeal circulation, the dosage of the considered solution is 1.5 mg per 100 IU of heparin.
The maximum duration of therapy with the agent in question is 3 days.
Side action
Can protamine sulfate cause adverse reactions? The instruction states that, in general, this drug is relatively well tolerated by patients. However, in some cases, it can still cause negative effects on the immune, cardiovascular and digestive systems, as well as the skin:
- bradycardia, decreased blood pressure;
- vomiting and nausea;
- itching, skin rash, development of anaphylactoid reactions;
- feeling hot, feeling short of breath and redness of the skin.
Overdose cases and drug interactions
The solution in question, intended for intravenous administration, is incompatible with penicillins and cephalosporins. Due to the fact that it is an antagonist of low molecular weight heparins, this medicationmay increase the duration and intensity of non-depolarizing muscle relaxants.
Overdose of the drug may be accompanied by bleeding. This is due to the fact that the substance in question has a high anticoagulant activity. In this case, symptomatic treatment is required.
Special Information
What should I be aware of before injecting a solution like protamine sulfate? Experts say that the use of this drug should be strictly controlled by a doctor who is obliged to regularly monitor the patient's blood clotting.
Before administering this medication, make sure that the patient's blood volume is adequate. This is because hypovolemia greatly increases the risk of collapse.
Storage conditions, dispensing from pharmacies, expiration date
Is Protamine Sulfate sold freely in pharmacies? A prescription in Latin or Russian must be presented to the pharmacist, otherwise the medication will not be dispensed.
Keep the agent in question out of the reach of children and protected from sunlight, where the air temperature is from 4 to 10 degrees. It should also be noted that the intravenous solution "Protamine sulfate" should never be frozen.
The shelf life of this medication is 4 years from the date of manufacture. It should not be used after this period.
Analogues of the drug and reviews about it
Analoguesthere is not much to consider. The intravenous solution can be replaced with drugs such as Protamine and Protamine-Ferein.
As for consumer feedback, almost all of them are positive. "Protamine sulfate" is a very effective and efficient remedy available to everyone. This is the opinion of most patients. They claim that this drug does not allow heparin to slow down the process of blood clotting, improving the patient's condition with severe bleeding.
Also, the advantages of this medicinal substance include its rapid and prolonged action. In addition, to achieve a therapeutic effect, the patient does not need to undergo long-term treatment. The maximum period of use of this drug is three days.
