protamine sulfate

Protamine is a mixture of highly basic peptides, which is used as drug. It belongs to the group of protamines and is mainly from the sperm or roe of certain species of salmon - particularly the Ketalachses (Oncorhynchus keta ) and chinook salmon (Oncorhynchus tshawytcha ) - isolated by extraction with mineral acids. It comprises more than two thirds of the L- arginine. Is not used in the basic protamine itself, but its neutral and water-soluble salts of protamine sulfate and protamine.

Offset of the effect of heparin

Protamine forms a stable complex with heparin without anticoagulant effect. It therefore applies to fast picked up the heparin effect, for example prior to surgery ( preoperative ), as a countermeasure during surgery with heart - lung machine (strong anticoagulation during CPB time needed after lifting ), in the treatment of heparin overdoses and heparin-induced bleeding. In the low molecular weight heparins protamine neutralized almost completely the anti- IIa activity. Anti- Xa activity is only partially neutralized. Fondaparinux is not inhibited. The effect occurs rapidly, within 5 to 15 minutes, a. Protamine itself also has a mild anticoagulant effect, so that it can cause bleeding in overdose. Protamine is injected or infused to avoid overdosing therefore slowly and under the supervision of the coagulation status. Also a too rapid administration may have a sudden strong decrease in blood pressure with slower heart shock. Another non- common side effect is pulmonary hypertension.

Delay of insulin action

Protamine is combined as a pharmaceutical excipient and, in conjunction with zinc ions with insulin in order to delay the onset and to extend the duration of action. This modified insulin NPH ( neutral protamine Hagedorn - called insulin).