- Management of coagulation disorders when caused by vitamin K deficiency or interference with vitamin K activity
- Hemorrhagic disease of the newborn
- Hemorrhagic situations due to overdose of oral anticoagulants
- For warfarin reversal during a code transfusion (massive hemorrhage)
- Available as 2 mg/mL and 10 mg/mL ampoules. Store at room temperature
- Protect from light
- Use immediately after dilution - discard unused portions
- Compatible for 24 hours in TPN
- Solutions Compatible: D5W, NS, ringer's solution, ringer's lactate
- Additive/buretrol Compatible: TPN (amino acids/dextrose)
- Y-site Compatible: heparin, KCl (up to 40 mmol/L)
- Incompatible: no information
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | YES, preferred route |
| IM | YES Usual dilution: undiluted |
| IV Direct |
YES, in emergencies |
| IV Intermittent Infusion | YES, only if other routes are not feasible Usual dilution: 0.5 mg/mL Infusion time: 15-30 minutes Infusion rate: do not exceed 1 mg/minute |
| IV Continuous Infusion | YES, TPN only (daily dose of phytonadione may be added to TPN) |
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Pediatric:
- Hemorrhagic disease of the newborn:
- Prophylaxis: 0.5-1 mg SC/IM within 1hour of birth; may repeat if necessary 6-8 hours later
- Treatment: 1-2 mg/dose/day SC/IM
- Oral anticoagulant overdose:
- No bleeding, future need for anticoagulant : 0.5-2 mg SC/IV
- No bleeding, no future need for anticoagulant OR Significant bleeding, not life-threatening: 2-5 mg SC/IV
- Significant bleeding, life-threatening: 5 mg IV
- Vitamin K deficiency: (due to drugs, malabsorption, decreased synthesis of vitamin K)
- 1-2 mg/dose IM/IV/SC as a single dose
- For warfarin reversal during code transfusion (massive hemorrhage)
| Age and Weight | Dose (mg) |
| Neonate | 1 mg |
| Child ≤35kg | 5 mg |
| Child > 35kg | 10mg |
Adults:
- Oral anticoagulant overdose:
- 2.5-10 mg/dose SC/IV; may repeat in 6-8 hours
- Maximum: 25-50 mg has been used
- Vitamin K deficiency: (due to drugs, malabsorption, decreased synthesis of vitamin K)
- 10 mg/dose IM/IV/SC as a single dose
- The IV & IM route should be restricted to those situations where SC/oral routes are not feasible
- IV and IM administration may produce severe reactions including shock and cardiac or respiratory arrest
- Possibility of allergic sensitivity and anaphylaxis after IV or IM administration
- Hypotension, bronchospasm, cyanosis, tachycardia, peripheral vascular collapse
- Flushing, sweating,
- Pain, swelling, tenderness at injection site
- Monitor PT
- Injectable form may be given orally
- Blood coagulation factors increase within 1-2 hours following parenteral administration; prothrombin time may become normal after 12-14 hours
- Ineffective in hereditary hypoprothrombinemia and hypoprothrombinemia caused by severe liver disease
- Contains benzyl alcohol