Formulary
Phytomenadione: Indications, Dosing, Side Effects and Interactions
Phytomenadione clinical drug profile including indications, dosing, side effects, cautions and interactions.
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Phytomenadione: Indications, Dosing, Side Effects and Interactions
Phytomenadione clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Major bleeding in patients on warfarin (in combination with dried prothrombin complex or fresh frozen plasma)**
- **Adult** (By Slow Intravenous Injection): 5 mg for 1 dose, stop warfarin treatment.
**INR > 8.0 with minor bleeding in patients on warfarin**
- **Adult** (By Slow Intravenous Injection): 1-3 mg for 1 dose, 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**
- **Adult** (By Mouth): 1-5 mg for 1 dose, 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**
- **Adult** (By Slow Intravenous Injection): 1-3 mg for 1 dose, stop warfarin treatment, restart warfarin treatment when INR <5.
**Reversal of anticoagulation prior to elective surgery (after warfarin stopped)**
- **Adult** (By Mouth): 1-5 mg for 1 dose, 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)**
- **Adult** (By Intravenous Injection): 5 mg for 1 dose, if surgery cannot be delayed, dried prothrombin complex can be given in addition to phytomenadione and the INR checked before surgery.
**Neonatal prophylaxis of vitamin-K deficiency bleeding for phytomenadione**
- **Preterm neonate** (By intramuscular injection): 400 micrograms/kg for 1 dose (max. per dose 1 mg), to be given at birth, the intravenous route may be used in preterm neonates with very low birth-weight if intramuscular injection is not possible, however, it may not provide the prolonged protection of the intramuscular injection, any neonate receiving intravenous vitamin-K should be given subsequent oral doses.
- **Neonate** (By intramuscular injection): 1 mg for 1 dose, to be given at birth.
**Neonatal hypoprothrombinaemia, Vitamin-K deficiency bleeding for phytomenadione**
- **Neonate** (By intravenous injection): 1 mg every 8 hours as required.
**Neonatal biliary atresia and liver disease for phytomenadione**
- **Neonate** (By mouth): 1 mg daily.
**Reversal of coumarin anticoagulation when continued anticoagulation required or if no significant bleeding-seek specialist advice for phytomenadione**
- **Child** (By intravenous injection): 15-30 micrograms/kg for 1 dose (max. per dose 1 mg), dose may be repeated as necessary.
**Reversal of coumarin anticoagulation when anticoagulation not required or if significant bleeding-seek specialist advice, Treatment of haemorrhage associated with vitamin-K deficiency-seek specialist advice for phytomenadione**
- **Child** (By intravenous injection): 250-300 micrograms/kg for 1 dose (max. per dose 10 mg).
**Neonatal prophylaxis of vitamin-K deficiency bleeding in healthy babies who are not at risk of bleeding disorders for Konakion MM Paediatric**
- **Neonate** (By mouth): Initially 2 mg for 1 dose, to be given at birth, then 2 mg for 1 dose, to be given at 4-7 days of age.
**Neonatal prophylaxis of vitamin-K deficiency bleeding in healthy babies who are not at risk of bleeding disorders (exclusively breast fed babies) for Konakion MM Paediatric**
- **Neonate** (By mouth): Initially 2 mg for 1 dose, to be given at birth, then 2 mg for 1 dose, to be given at 4-7 days of age, then 2 mg for 1 dose, to be given at 1 month of age.
**Neonatal prophylaxis of vitamin-K deficiency bleeding in healthy babies who are not at particular risk of bleeding disorders for NeoKay**
- **Neonate** (By mouth): 1 mg for 1 dose, to be given at birth (to protect from the risk of vitamin-K deficiency bleeding in the first week).
**Neonatal prophylaxis of vitamin-K deficiency bleeding in healthy babies who are not at particular risk of bleeding disorders (exclusively breast-fed babies) for NeoKay**
- **Neonate** (By mouth): Initially 1 mg for 1 dose, to be given at birth, then 1 mg every week for 12 weeks.
Cautions
Intravenous injections should be given very slowly-reports of anaphylactoid reactions Cautions For Konakion MM Reduce dose in elderly
Interactions
**Severe interactions:**
- No significant interactions are known other than antagonism of coumarin anticoagulants.
Pregnancy
Use if potential benefit outweighs risk.
Breast feeding
Present in milk.
Hepatic impairment
For Konakion MM Manufacturer advises caution-monitor INR in patients with severe impairment (contains glycocholic acid which may displace bilirubin).
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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