Protamine Sulfate (Prosulf)

Anesthesia Implications

Classification: Heparin Antagonist
Therapeutic Effects: Lowers ACT values, antagonizes heparin affects

Primary Considerations

Can cause severe hypotension. This is caused, at least in part, by histamine release by degranulation of isolated Mast Cells. Diphenhydramine (Benadryl) can be given to prevent or attenuate the Histamine induced hypotension.

Sometimes given with calcium chloride to counter the hypotensive effects. Should be slow pushed (over 10-15 minutes) while monitoring hemodynamic effects.

Risk of anaphylaxis in men with vasectomies or patients with diabetes.

IV push dose

1 mg/100 u of Heparin previously administered. Give SLOWLY and monitor hemodynamic effects. The administration should be IV push at a rate that should not exceed 50 mg over a 10 minute period.

Method of Action

Protamine neutralizes heparin through electrostatic interaction, forming a heparin-protamine complex that renders heparin inactive