What are adverse effects of protamine sulfate?

By William Aird

  • Anaphylaxis in patients previously been exposed to protamine, including diabetic patients who have received protamine-containing insulin (eg, NPH, PZI), and individuals with fish allergy (protamine is derived from fish). 
  • Boxed Warning includes the following adverse events in patients who have previously received protamine sulfate or other protamine-containing drugs (e.g., NPH insulin, protamine zinc insulin, and certain beta-blockers):
    • Hypotension
    • Cardiovascular collapse
    • Non-cardiogenic pulmonary edema
    • Catastrophic pulmonary vasoconstriction
    • Pulmonary hypertension