An injectable form of vitamin K1 that helps the liver make clotting factors. It reverses bleeding problems from warfarin-type blood thinners or low vitamin K, and it is given to newborns to prevent bleeding.
Phytonadione is not on the ISMP acute care high-alert list. The anticoagulants it reverses, such as warfarin, are.
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The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug. Dosing is guided by the INR, not by phytonadione levels.
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IV and IM injection have caused fatal hypersensitivity reactions, including anaphylaxis, during or right after the dose, even when diluted and on the first dose. Give it subcutaneously unless that route is not feasible and the serious risk of IV or IM use is justified.
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None. Treat hypersensitivity reactions as an emergency, and stop the drug for skin reactions and manage medically. Newborn overdose can cause hemolysis, jaundice, and hyperbilirubinemia. If reversal goes too far while anticoagulation is still needed, heparin still works because phytonadione does not affect it.
Doses come from the FDA label. Study tool, not for clinical decisions.
No renal dose adjustment on the label. The product contains aluminum, which can reach toxic levels with prolonged parenteral use when kidney function is impaired.
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No set adjustment. In liver disease, do not keep repeating large doses after a poor first response; failure to respond may mean the condition cannot respond to vitamin K.
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Vitamin K1 replacement. It is a cofactor for the hepatic microsomal enzyme that carboxylates glutamic acid residues on the inactive precursors of factors II, VII, IX, and X, activating them for secretion. It has almost no activity in people who are not vitamin K deficient. IV: effect detectable within 1 to 2 hours, bleeding usually controlled in 3 to 6 hours, INR often normal in 12 to 14 hours.