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Protamine sulfate replaced hexadimethrine bromide (Polybrene), another cationic agent that was the original heparin reversal agent in the early days of heart surgery, until studies in the 1960s suggested that hexadimethrine bromide might cause kidney failure when used in doses in excess of its therapeutic range.
Protamine sulfate [51] Table 1: antidotes for cardiovascular agent overdose For patients taking antihyperlipidemic agents, liver function tests have to be conducted before and during the therapy to monitor the elevation of liver enzymes which may result in hepatotoxicity , especially for those undergoing statin therapy . [ 52 ]
Protamine sulfate is an antidote for heparin overdose, but severe allergy may occur. [10] A chain shortened version of protamine also acts as a potent heparin antagonist, but with markedly reduced antigenicity.
Protamine insulin was first created in 1936 and NPH insulin in 1946. [1] It is on the World Health Organization's List of Essential Medicines. [4] NPH is an abbreviation for "neutral protamine Hagedorn". [1] In 2020, insulin isophane was the 221st most commonly prescribed medication in the United States, with more than 2 million prescriptions.
Hepatin's anticoagulant effects are typically reversible with protamine sulfate, while protamine's effect on LMWH is limited. LMWH has less of an effect on thrombin than heparin, but about the same effect on Factor Xa. Due to its renal clearance, LMWH is contraindicated in patients with kidney disease who can safely use unfractionated heparin.
The first step in management of a protamine reaction is to immediately stop the protamine infusion. Corticosteroids are used for all types of protamine reactions. Chlorphenamine is used for type II (anaphylactic) reactions. For type III reactions, heparin is redosed and the patient may need to go back on bypass. [13]
Local policy determines whether the patient or a coagulation specialist (pharmacist, nurse, general practitioner or hospital doctor) interprets the result and determines the dose of medication. In Germany and Austria, patients may adjust the medication dose themselves, [ citation needed ] while in the UK and the US this remains in the hands of ...
Patients use a zero-cost helpline to report outcomes every 2–3 months related to adherence, medicine availability, seizure frequency, healthcare related quality of life, and a few other parameters. All PROMs are analyzed [33] to help guide public policy and optimize resource allocation for people living with epilepsy in Maharashtra.