Parenteral Manual

Phytonadione

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
VITAMIN K-1
Classification: 
Vitamin
Original Date: 
August 2005
Revised Date: 
December 2019
Indications: 
  • 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
Reconstitution and Stability: 
  • 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
Compatibility: 

- 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

Administration: 

(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
Usual dilution: undiluted or diluted in 10 mL of compatible solution
Infusion rate: do not exceed 1 mg/minute

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)
Dosage: 

(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

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

Potential hazards of parenteral administration: 
  • 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                                               
Notes: 
  • 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

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