Names and pronunciation
(fye-toe-na-dye′one) Mephyton, Vitamin K
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Drug reference
(fye-toe-na-dye′one) Mephyton, Vitamin K
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Func. class.: Vitamin K1, fat-soluble vitamin
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Do not confuse: Mephyton/methadone
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ACTION: Needed for adequate blood clotting (factors II, VII, IX, X)
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USES: Vit K malabsorption, hypopro thrombinemia, prevention of hypopro thrombinemia caused by oral anticoag ulants, prevention of hemorrhagic disease of the newborn
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CONTRAINDICATIONS: Hyper sensitivity, severe hepatic disease, last few weeks of pregnancy Precautions: Pregnancy, neonates, hepatic disease, IV use
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Black Box Warning: Risk of anaphylaxis (IV/IM)
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SIDE EFFECTS CNS: Headache, brain damage (large P doses) GI: Nausea, decreased LFTs HEMA: Hemolytic anemia, hemoglobin- uria, hyperbilirubinemia INTEG: Rash, urticaria RESP: Bronchospasm, dyspnea, feeling of chest constriction, respiratory arrest
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INTERACTIONS Decrease: action of phytonadione—bile acid sequestrants, sucralfate, antiinfec- tives, salicylates, mineral oil Decrease: action of warfarin—large dose of product
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DOSAGE AND ROUTES Hypoprothrombinemia caused by vit K malabsorption • Adult: PO/IM 2.5-25 mg, may repeat or increase to 50 mg • Child: PO 2.5-5 mg • Infant: PO/IM 2 mg Prevention of hemorrhagic disease of the newborn • Neonate: IM 0.5-1 mg within 1 hr af- ter birth Hypoprothrombinemia caused by other cause • Adult/child: PO/SUBCUT/IM 2.5-10 mg, may repeat 12-48 hr Warfarin-induced hypoprothrombinemia: Adults with INR < 4.5 with no signifi cant bleeding: Lower/omit warfarin dose and monitor INR more frequently; reinitiate therapy at a lower dose when therapeutic INR is reached INR 4.5-10 with no evidence of bleeding: do not use vitamin K, omit the next 1-2 doses of warfarin, monitor the INR more frequently, reinitiate therapy at a lower dose when therapeutic INR is reached; serious bleeding at any elevation of INR: 5-10 mg IV by slow infusion in addi- tion to 4-factor prothrombin complex concentrate. Hold warfarin therapy Adults with INR >10 with no significant bleeding PO 2.5-5 mg with the expecta- tion that the INR would be reduced sub- stantially in 24-48 hr. Hold warfarin, monitor INR more frequently Infants, children, and adolescents (unlabeled): IV 30 mcg/kg/dose, with excessively prolonged INR (typically more than 8) with no bleeding; signifi- cant bleeding, immediate reversal us- ing fresh-frozen plasma (FFP), pro- thrombin complex concentrates, or recombinant factor VIIa
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Available forms: Tabs 5 mg; inj 10 mg/ mL, 1 mg/0.5 mL
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Administer: • Store in tight, light-resistant container (PO) IM route • Use this route only when other routes cannot be used (deaths may occur due to allergic reactions) Intermittent IV INFUSION route • After diluting with ≥10 mL D5W, NS, D5NS; give by slow infusion over 30-60 min, route/mg/min • VS q15min, check for hypersensitivity • INR effect in 4-6 hr • Do not use direct or bolus Y-site compatibilities: Alfentanil, amika- cin, aminophylline, ascorbic acid, atracu- rium, atropine, azaTHIOprine, aztreonam, bumetanide, buprenorphine, butorpha- nol, calcium chloride/gluconate, ceFAZo- lin, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, cefti- zoxime, cefTRIAXone, cefuroxime, chlor- amphenicol, chlorproMAZINE, cimeti- dine, clindamycin, cyanocobalamin, cycloSPORINE, dexamethasone, digoxin, diphenhydrAMINE, DOPamine, doxycycline, enalaprilat, ePHEDrine, EPI- NEPHrine, epoetin alfa, erythromycin, esmolol, famotidine, fentaNYL, flucon- azole, folic acid, furosemide, ganciclovir, gentamicin, glycopyrrolate, heparin, hydrocortisone, imipenem/cilastatin, indomethacin, insulin, isoproterenol, ketorolac, labetalol, lidocaine, mannitol, meperidine, metaraminol, methoxamine, methyldopate, metoclopramide, metopro- lol, metroNIDAZOLE, midazolam, mor- phine, multivitamins, nafcillin, nalbu- phine, naloxone, nitroglycerin, nitroprusside, norepinephrine, ondanse- tron, oxacillin, oxytocin, papaverine, peni- cillin G potassium, pentamidine, pentazo- cine, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, potassium chloride, procainamide, prochlorpera- zine, propranolol, pyridoxine, raNITIdine, sodium bicarbonate, succinylcholine, SUFentanil, theophylline, thiamine, ticar- cillin/clavulanate, tobramycin, tolazoline, trimetaphan, urokinase, vancomycin, vasopressin, verapamil, vit B with C
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Assess: • Increased bleeding risk: emesis, stools, urine; pressure on all venipunc- ture sites; avoid all inj if possible • PT, INR during treatment (2-sec devia- tion from control time, bleeding time, clotting time, INR); monitor for bleeding, pulse, and B/P • Hypersensitivity: monitor closely • Pregnancy/breastfeeding: usually not needed in pregnancy; may breastfeed
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Evaluate: • Therapeutic response: prevention of hemorrhagic disease of the newborn, resolution of hypoprothrombinemia
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Not to take other supplements, OTC products, prescription products unless directed by prescriber • About the necessary foods for associ- ated diet • To avoid IM inj; to use soft toothbrush; not to floss; to use electric razor until coagulation defect corrected • To report symptoms of bleeding • About the importance of frequent lab tests to monitor coagulation factors • To notify all health care providers of use of this product • To carry emergency ID describing con- dition and products used See Appendix B See Appendix B
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PHARMACOKINETICS PO: Onset 6-10 hr; peak 24-48 hr SUBCUT: Erratic, crosses placenta, metabolized in the liver, excreted in urine/feces
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• Infant: PO/IM 2 mg Prevention of hemorrhagic disease of the newborn
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