Phytomenadione (Vitamin K1)

Indications & Dose:

Major bleeding in patients on warfarin (in combination with dried prothrombin complex or fresh frozen plasma)  

• BY SLOW INTRAVENOUS INJECTION

Adult: 5 mg for 1 dose, stop warfarin treatment INR > 8.0 with minor bleeding in patients on warfarin 

• BY SLOW INTRAVENOUS INJECTION

Adult: 1–3 mg, stop warfarin treatment, dose may be repeated if INR still too high after 24 hours, restart warfarin treatment when INR <5 INR > 8.0 with no bleeding in patients on warfarin  

• BY MOUTH
  

Adult: 1–5 mg, intravenous preparation to be used orally, stop warfarin treatment, repeat dose if INR still too high after 24 hours, restart warfarin treatment when INR <5 INR 5.0–8.0 with minor bleeding in patients on warfarin l

• BY SLOW INTRAVENOUS INJECTION

Adult: 1–3 mg, stop warfarin treatment, restart warfarin treatment when INR <5 Reversal of anticoagulation prior to elective surgery (after warfarin stopped)

• BY MOUTH
  

Adult: 1–5 mg, intravenous preparation to be used orally, dose to be given the day before surgery if INR 1.5

Reversal of anticoagulation prior to emergency surgery (when surgery can be delayed 6–12 hours)  

• BY INTRAVENOUS INJECTION

Adult: 5 mg as a single dose, if surgery cannot be delayed, dried prothrombin complex can be given in addition to phytomenadione and the INR checked before surgery 

Contraindications:

Severe hepatic disease.

Side Effects:

Cautions:

Precautions:

G-6-PD deficiency; premature infants; correction of anticoagulant-induced hypoprothrombinemia in patients with continued needs for anticoagulation should be approached cautiously; consider minidosing (12.5 mg) 

Interaction:

Drugs
Oral anticoagulants: Decreased anticoagulant effect 

Warnings:

Adverse Effects:

Lactations:

Oral supplementation of women on anticonvulsants during last 2 weeks of pregnancy has been done to prevent HDN, but effectiveness unproven; compatible with breast feeding 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Headache, kernicterus (premature infants high doses)
HEM: Hemoglobinuria, hemolyticanemia, hyperbilirubinemia (newborn)
SKIN: Flushing sensation, rash, urticaria
MISC: Anaphylaxis 

Patient And Carer Advice: