Protamine¶
Overview¶
| Field | Detail |
|---|---|
| Drug class | Heparin reversal agent |
| Route | IV |
| Stock formulation | 50 mg/5 mL |
| Reconstituted conc. | N/A (10 mg/mL ready to use) |
| Diluent | Nil |
| Storage | Refrigerate 2–8 °C; do not freeze |
Preparation¶
Before you start
Check the expiry date and vial integrity before opening. Label every syringe immediately after drawing up — never leave unlabelled syringes on the tray.
Equipment needed¶
- 1 × Protamine 50 mg/5 mL (10 mg/mL) vial
- Normal saline (NS) — for IDT dilutions
- 1 mL syringes × 3
- 25 G needles
Step 1 — Prepare the SPT solution (10 mg/mL — neat)¶
- Draw up 0.5–1 mL of the stock (10 mg/mL) into a 1 mL syringe.
- Label: "Protamine SPT 10 mg/mL".
Step 2 — Prepare IDT dilutions¶
Prepare in this order, using a fresh syringe for each step.
-
IDT 0.01 mg/mL (1:1,000):
- Draw 0.1 mL of stock (10 mg/mL) into a 1 mL syringe. Add 0.9 mL NS. Mix. (This is 1 mg/mL — 1:10).
- Draw 0.1 mL of this 1 mg/mL into a new 1 mL syringe. Add 0.9 mL NS. Mix. (This is 0.01 mg/mL — 1:1,000).
- Label: "Protamine IDT 0.01 mg/mL".
-
IDT 0.05 mg/mL (0.1:20):
- Draw 0.1 mL of stock (10 mg/mL) into a 1 mL syringe. Add 1.9 mL NS. Mix. (This is 0.05 mg/mL — 0.1:20).
- Label: "Protamine IDT 0.05 mg/mL".
Unusual dilution
The 0.1:20 dilution for Step 2 is non-standard. Ensure accuracy when measuring 0.1 mL stock + 1.9 mL NS.
Skin prick test (SPT)¶
| Reagent | Concentration |
|---|---|
| Test solution | Neat (10 mg/mL) |
| Positive control | Histamine 10 mg/mL |
| Negative control | Normal saline |
Interpretation: Wheal ≥3 mm vs negative control = positive.
Intradermal test (IDT)¶
Dilution series¶
| Step | Dilution | Concentration | Preparation |
|---|---|---|---|
| 1 | 1:1,000 | 0.01 mg/mL | 0.1 mL of 1 mg/mL + 0.9 mL NS |
| 2 | 0.1:20 | 0.05 mg/mL | 0.1 mL of 10 mg/mL + 1.9 mL NS |
Inject: 0.05 mL intradermal. Read at 15–20 minutes.