硫酸魚精蛋白
Protamine Sulfate
Protamini sulfas
別名: Prosulf · protamine sulphate · protamini sulfas · sulfato de protamina · Protamine sulfate
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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 | — | 🌎 NA |
| 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 | — | 🌎 NA |
- Heparin overdosage: Give slowly.
- Heparin overdosage: May be ineffective if heparin was given deep SC. Do not give faster than 50 mg over 10 minutes.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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 | — | 🌎 NA |
| 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 | — | 🌎 NA |
- Heparin overdosage: Give slowly.
- Heparin overdosage: May be ineffective if heparin was given deep SC. Do not give faster than 50 mg over 10 minutes.
牛
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Bracken Fern (Pteridium spp.) poisoning | 1 injection of 10 mL of 1% protamine sulfate IV | IV | Single dose | — | 🌎 NA |
- Bracken Fern (Pteridium spp.) poisoning: In combination with whole blood (2.25-4.5 L)
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
硫酸魚精蛋白 (Protamine sulfate) 是一種簡單、低分子量的陽離子蛋白質，最初提取自鮭魚及相關魚類的精子或成熟睪丸。在獸醫學中，它主要作為肝素 (Heparin) 過量導致嚴重、無法控制的出血時的特效解毒劑。
主要臨床重點：
- 未分段肝素 vs. 低分子量肝素 (LMWH)： 雖然魚精蛋白能完全中和未分段肝素，但它只能部分中和低分子量肝素（如 dalteparin 或 enoxaparin）的抗 Xa 活性。然而，它仍能改善 LMWH 過量引起的微血管出血。
- 其他用途： 曾被建議作為反芻動物蕨類植物 (Pteridium spp.) 中毒的輔助治療。
臨床提示： 由於魚精蛋白是一種外來蛋白質，可能會引起過敏反應（包括過敏性休克），特別是在曾有暴露史或對魚類過敏的病患中。
作用機制
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.
安全性與警告
禁忌症
- Known hypersensitivity or intolerance to protamine
- Hypersensitivity to protamine
- Conditions where heparin has not been administered
不良反應
- Acute hypotension (if given too rapidly)
- Bradycardia
- Pulmonary hypertension
- Dyspnea
- Hypersensitivity/Anaphylaxis
- Heparin 'rebound' effect (bleeding hours after neutralization)
- Anaphylactoid reactions
- Paradoxical bleeding (at high doses)
注意事項
Administration Warnings
- Rate of Injection: Must be administered via slow IV injection (over 1-3 minutes). Rapid IV injection can cause severe acute hypotension, bradycardia, pulmonary hypertension, and dyspnea. Do not exceed a rate of 50 mg over a 10-minute period.
- Heparin Rebound: A 'rebound' effect may occur where anticoagulation and bleeding resume several hours after apparent neutralization. This is likely due to the release of heparin from extravascular compartments or degradation of the protamine-heparin complex by fibrinolysin.
- Pregnancy: FDA Category C. Use only if clearly needed.
藥物相互作用
Forms a stable salt, causing the loss of anticoagulant activity of both compounds (therapeutic intent).
監測
- 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)
- Signs of anaphylaxis during administration
藥物動力學
半衰期
吸收
Binds to heparin within 5 minutes after IV injection.
分佈
Forms a complex with heparin in the intravascular space.
代謝
The exact metabolic fate is unknown, but evidence suggests the heparin-protamine complex is partially metabolized and/or degraded by fibrinolysin, which can free previously bound heparin.
排除
Clearance mechanisms are not fully defined, but degradation of the complex can lead to a clinical 'rebound' effect.
過量
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.
可用產品
劑型
- Injection: 10 mg/mL
- 10 mg/ml injectable solution
人用標示
- Protamine Sulfate Injection: 10 mg/mL preservative-free in 5 mL and 25 mL vials
- Protamine sulphate 10 mg/ml solution for injection
各地核准狀態
POM (Prescription Only Medicine)
POM (Prescription Only Medicine)
暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Powder for injection: Store at room temperature (15-30°C). Liquid injection: Store in the refrigerator (2-8°C); avoid freezing (though stable at room temperature for at least 2 weeks). Reconstituted powder: Use immediately if mixed with Sterile Water for Injection, or within 72 hours if mixed with Bacteriostatic Water for Injection. Compatible with D5W, normal saline, cimetidine, and verapamil.
飼主須知
寵物主人重要須知
- 僅限急救使用： 硫酸魚精蛋白是一種專門的急救藥物，僅在醫院環境中使用，用於治療因肝素過量引起的嚴重出血。
- 密集監測： 您的寵物在接受此藥物時將在加護病房接受密切監測，因為如果注射過快，可能會導致血壓或心跳突然下降。
- 反彈性出血： 即使治療成功，您的寵物仍需要觀察幾個小時，因為肝素的出血效應有時會「反彈」並再次出現。
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