phytonadione

ROUTE	ONSET	PEAK‡	DURATION‡
PO	6–12 hr	unknown	unknown
SUBQ	1–2 hr	3–6 hr	12–14 hr
IV	1–2 hr	3–6 hr	12 hr

Contraindicated in:

Hypersensitivity;
Hypersensitivity or intolerance to benzyl alcohol (injection only).

Use Cautiously in:

Hepatic impairment;
Pedi: Use of injection formulations containing benzyl alcohol may lead to gasping syndrome in neonates and infants.

Exercise Extreme Caution in:

Severe life-threatening reactions have occurred following IV administration; use other routes unless risk is justified.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: eczematous reactions, flushing, kernicterus, rash, scleroderma-like lesions, urticaria

GI: gastric upset, hyperbilirubinemia (large doses in very premature infants), unusual taste

Hemat: hemolytic anemia

Local: erythema, pain at injection site, swelling

Misc: HYPERSENSITIVITY REACTIONS

Interactions ⬆ ⬇

Drug-drug:

Large doses will counteract the effect of warfarin.
Large doses of salicylates or broad-spectrum anti-infectives may ↑ vitamin K requirements.
Bile acid sequestrants, mineral oil, and sucralfate may ↓ vitamin K absorption from the GI tract.

Route/Dosage ⬆ ⬇

IV use of phytonadione should be reserved for patients with serious or life-threatening bleeding and elevated INR. Oral route is preferred in patients with elevated INRs and no serious or life-threatening bleeding. IM route should generally be avoided because of risk of hematoma formation.

Treatment of Hypoprothrombinemia Due to Vitamin K Deficiency (From Factors Other Than Warfarin)

SC IV (Adults ): 10 mg as single dose.
PO (Adults ): 2.5–25 mg/day.
SC IV (Children >1 mo): 1–2 mg as single dose.
PO (Children >1 mo): 2.5–5 mg/day.

Vitamin K Deficiency (Supratherapeutic INR) Secondary to Warfarin

PO (Adults ): INR ≥5 and <9 (no significant bleeding): Hold warfarin and give 1–2.5 mg vitamin K; if more rapid reversal required, give ≤5 mg vitamin K; INR >9 (no significant bleeding): Hold warfarin and give 2.5–5 mg vitamin K.
IV (Adults ): Elevated INR with serious or life-threatening bleeding: 10 mg slow infusion.

Prevention of Hypoprothrombinemia During Total Parenteral Nutrition

IV (Adults ): 5–10 mg once weekly.
IV (Children ): 2–5 mg once weekly.

Prevention of Vitamin K–Deficiency Bleeding in Neonates

IM (Neonates ): 0.5–1 mg within 1 hr of birth; may repeat in 6–8 hr if needed. May be repeated in 2–3 wk if mother received previous anticonvulsant/anticoagulant/anti-infective/antitubercular therapy. 1–5 mg may be given IM to mother 12–24 hr before delivery.

Treatment of Vitamin K–Deficiency Bleeding in Neonates

IM SC (Neonates ): 1–2 mg/day.

Availability ⬆ ⬇

(Generic available)

Tablets: 5 mg
Solution for injection: 1 mg/0.5 mL; 10 mg/mL

Assessment ⬆ ⬇

Monitor for signs and symptoms of occult bleeding (weakness, dizziness, pallor, petechiae, ecchymosis, guaiac stools, coffee ground emesis) or frank hemorrhage (epistaxis, bleeding gums, hematuria, rectal blood).
Monitor HR and BP frequently; notify health care provider immediately if symptoms of internal bleeding or hypovolemic shock develop. Inform all personnel of patient’s bleeding tendency to prevent further trauma. Apply pressure to all venipuncture sites for ≥5 min; avoid unnecessary IM injections.
Monitor for signs/symptoms of hypersensitivity reactions (rash, urticaria, pruritus, flushing, dizziness, vomiting, abdominal pain) and angioedema (swelling of throat, lips, tongue, or face; dyspnea; wheezing; hoarseness). If hypersensitivity reaction or angioedema occur, discontinue phytonadione immediately and provide supportive care.
Pedi: Monitor for side effects and adverse reactions. Children (especially neonates) may be especially sensitive to the effects and side effects of vitamin K.

Lab Test Considerations:

Monitor INR at baseline and during therapy to determine response and need for further therapy.

Implementation ⬆ ⬇

Administration of whole blood or plasma may also be required in severe bleeding because of the delayed onset of phytonadione.
- Phytonadione is an antidote for warfarin overdose but does not counteract the anticoagulant activity of heparin.
PO: Administer without regard to food.
- PO is the recommended route, except when the clinical disorder prevents absorption. If parenteral administration is needed, SUBQ is the preferred route; IV and IM routes should be avoided whenever possible.
  Fatal hypersensitivity reactions, including anaphylaxis, have occurred during and immediately after IV and IM injection of phytonadione.
SC: Inject into the SUBQ tissue of the upper arms, outer side of upper thighs, or the abdomen (≥2 inches away from the umbilicus). Apply pressure for ≥ 5 min.
IM: Inject into the anterolateral aspect of the thigh (neonates and infants). Apply pressure for ≥ 5 min.

IV Administration:

Intermittent Infusion: Diluent: Dilute in 50 mL of 0.9% NaCl, D5W, or D5/0.9% NaCl.
Rate: Administer over 30–60 min. Rate should not exceed 1 mg/min.
Y-Site Compatibility:
- amikacin
- aminophylline
- ascorbic acid
- atracurium
- atropine
- azathioprine
- aztreonam
- benztropine
- bumetanide
- buprenorphine
- butorphanol
- calcium chloride
- calcium gluconate
- cefazolin
- cefotaxime
- cefotetan
- cefoxitin
- ceftazidime
- ceftriaxone
- cefuroxime
- chloramphenicol
- chlorpromazine
- clindamycin
- cyanocobalamin
- cyclosporine
- dexamethasone
- digoxin
- diphenhydramine
- dopamine
- doxycycline
- enalaprilat
- ephedrine
- epinephrine
- epoetin alfa
- erythromycin
- esmolol
- famotidine
- fentanyl
- fluconazole
- folic acid
- furosemide
- ganciclovir
- gentamicin
- glycopyrrolate
- heparin
- hydrocortisone
- imipenem/cilastatin
- insulin regular
- isoproterenol
- ketorolac
- labetalol
- lidocaine
- mannitol
- meperidine
- metoclopramide
- metoprolol
- midazolam
- minocycline
- morphine
- multivitamins
- nafcillin
- nalbuphine
- naloxone
- nitroglycerin
- nitroprusside
- norepinephrine
- ondansetron
- oxacillin
- oxytocin
- papaverine
- penicillin G
- pentamidine
- pentobarbital
- phenobarbital
- phentolamine
- phenylephrine
- potassium chloride
- procainamide
- prochlorperazine
- propranolol
- pyridoxine
- sodium bicarbonate
- succinylcholine
- sufentanil
- theophylline
- thiamine
- tobramycin
- vancomycin
- vasopressin
- verapamil
Y-Site Incompatibility:
- dantrolene
- diazepam
- magnesium sulfate
- phenytoin
- trimethoprim/sulfamethoxazole

Patient/Family Teaching ⬆ ⬇

Explain the purpose and side effects of phytonadione. Instruct to take as directed. Take missed doses as soon as remembered unless almost time for next dose. Notify health care provider of missed doses. Advise patient to read Patient Information before starting and periodically during therapy in case of changes.
Tell patient to report and seek treatment for signs and symptoms of bleeding (weakness; fast heartbeat; trouble breathing; dizziness; pale skin; tiredness; obvious bleeding in urine, stool, mouth, or nose; excessive menstrual flow).
Cooking does not destroy substantial amounts of vitamin K. Patient should not drastically alter diet while taking vitamin K. See Food Sources for Specific Nutrients for foods high in vitamin K.
Caution patient to avoid IM injections and activities leading to injury. Use a soft toothbrush, do not floss, and shave with an electric razor until coagulation defect is corrected.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications and alcohol.
Advise patient to inform health care provider of medication regimen prior to treatment or surgery.
Advise patient to carry identification at all times describing disease process.
Emphasize the importance of frequent lab tests to monitor coagulation factors.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇