프로타민 황산염

해독제 (헤파린 길항제)

**프로타민 황산염(Protamine sulfate)**은 연어 및 관련 어종의 정자나 성숙한 고환에서 추출한 단순하고 분자량이 낮은 양이온성 단백질입니다. 수의학에서는 주로 **헤파린 과다 투여**로 인해 심각하고 통제할 수 없는 출혈이 발생했을 때 특이적 해독제로 사용됩니다. 주요 임상 포인트: * **미분획 헤파린 vs 저분자량 헤파린(LMWH):** 프로타민은 미분획 헤파린을 완전히 중화하지만, 저분자량 헤파린(달테파린, 에녹사파린 등)의 항 Xa 활성은 *부분적으로만* 중화합니다. 그러나 LMWH 과다 투여와 관련된 미세혈관 출혈을 개선하는 데는 도움이 됩니다. * **대체 용도:** 반추동물의 고사리(*Pteridium spp.*) 중독에 대한 보조 치료제로 제안된 바 있습니다. > **임상 팁:** 프로타민은 외부 단백질이므로, 특히 과거 노출 병력이 있거나 생선 알레르기가 있는 환자에게서 과민 반응(아나필락시스 포함)이 발생할 수 있습니다.

작용 기전: Protamine works via direct **acid-base neutralization**. * **Mechanism:** Heparin is a strongly acidic molecule, while protamine is strongly basic. * **Pathway:** Protamine → binds directly to circulating heparin → forms an inactive, stable salt complex → neutralizes heparin's anticoagulant activity. > **Pharmacology Note:** Protamine possesses weak intrinsic anticoagulant activity of its own. If administered in large doses without heparin present, it can theoretically interfere with coagulation, though this rarely causes clinical hemorrhage.

동물 종별 용량

Cats

Heparin overdosage · 1-1.5 mg protamine sulfate to antagonize each mg (100 units) of heparin via slow IV injection. Reduce dose as time increases between heparin dose and start of treatment (after 30 minutes give only 0.5 mg). · IV · Single dose · Give slowly.
Heparin overdosage · Administer 1 mg protamine for each 100 Units of heparin to be inactivated. Decrease protamine dose by ½ for every 30 minutes that have lapsed since heparin was administered · IV · Single dose · May be ineffective if heparin was given deep SC. Do not give faster than 50 mg over 10 minutes.

Cattle

Bracken Fern (Pteridium spp.) poisoning · 1 injection of 10 mL of 1% protamine sulfate IV · IV · Single dose · In combination with whole blood (2.25-4.5 L)

Dogs

Heparin overdosage · 1-1.5 mg protamine sulfate to antagonize each mg (100 units) of heparin via slow IV injection. Reduce dose as time increases between heparin dose and start of treatment (after 30 minutes give only 0.5 mg). · IV · Single dose · Give slowly.
Heparin overdosage · Administer 1 mg protamine for each 100 Units of heparin to be inactivated. Decrease protamine dose by ½ for every 30 minutes that have lapsed since heparin was administered · IV · Single dose · May be ineffective if heparin was given deep SC. Do not give faster than 50 mg over 10 minutes.

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

금기

Known hypersensitivity or intolerance to protamine
Hypersensitivity to protamine
Conditions where heparin has not been administered

이상반응

Acute hypotension (if given too rapidly)
Bradycardia
Pulmonary hypertension
Dyspnea
Hypersensitivity/Anaphylaxis
Heparin 'rebound' effect (bleeding hours after neutralization)
Hypotension
Anaphylactoid reactions
Paradoxical bleeding (at high doses)

약물 상호작용

Heparin · Forms a stable salt, causing the loss of anticoagulant activity of both compounds (therapeutic intent). · major

모니터링

Coagulation parameters (e.g., aPTT, ACT) to assess heparin neutralization
Blood pressure (monitor for hypotension during administration)
Heart rate and rhythm (monitor for bradycardia)
Respiratory rate and effort
Signs of recurrent bleeding (heparin rebound effect) for several hours post-administration
Coagulation times (aPTT, ACT)
Heart rate
Blood pressure
Signs of anaphylaxis during administration

과용량

Because protamine has inherent, albeit weak, anticoagulant activity, massive overdoses could theoretically result in **hemorrhage**. However, clinical data in humans suggests that significant overdoses (600-800 mg) typically result in only mild, transient effects on coagulation. The LD50 of protamine in mice is reported to be 100 mg/kg. Treatment of overdose should be supportive.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.