The Drug-Induced Respiratory Disease Website and App
Frequency - Incidence
Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases
Evidence level/grade
Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic
Acute pulmonary hypertension
Can cause catastrophic hemodynamic instability. Occurs electively in the intra/perioperative period, during heparin reversal
Publications
The successful management of severe protamine-induced pulmonary hypertension using inhaled prostacyclin.
Anesthesia and analgesia. 2010;110(2):365-9
A case of catastrophic pulmonary vasoconstriction after protamine administration in cardiac surgery: role of intraoperative transesophageal echocardiography.
Journal of cardiothoracic and vascular anesthesia. 2008;22(5):727-31
The use of nitric oxide for managing catastrophic pulmonary vasoconstriction arising from protamine administration.
Anesthesia and analgesia. 1999;88(3):505-7
Protamine reactions, explosive mediator release, and pulmonary vasoconstriction.
Anesthesiology. 1990;73(3):373-5