Vitamin K

Vitamin K

[1 vial $10.84]

ADMINISTRATION ROUTES:

  • IV, PO

ALTERNATIVE NAMES:

  • Phytomenadione, konakion

ICU INDICATIONS:

  1. correction of elevated INR due to administration of warfarin or liver impairment

PRESENTATION AND ADMINISTRATION:

  • IV: 2mg in 0.2ml ampoules and 10mg in 1ml vials
    Usually administered in ICU by direct IV injection. Administer undiluted by very slow IV push over at least 30 seconds either direct or, where appropriate, into lower section of infusion set of a continuous infusion of normal saline or 5% glucose.
    Compatible when injected into the tubing of a continuous infusion of: Normal saline 5% glucose Store at room temperature.
  • PO: Konakion 10mg tablets (white to yellowish)

DOSAGE:

  • IV/ PO: 0.5-10mg; repeated as necessary (avoid large doses if anticoagulation is to be continued)

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • For warfarin reversal: 0.1mg/kg (max 5mg) IV or oral

CLINICAL PHARMACOLOGY:

  • Vitamin K is an essential cofactor for a microsomal enzyme that catalyzes the post- translational carboxylation of multiple, specific, peptide-bound glutamic acid residues in inactive hepatic precursors of factors II, VII, IX, and X. The resulting gamma- carboxyglutamic acid residues convert the precursors into active coagulation factors that are subsequently secreted by liver cells into the blood.

CONTRAINDICATIONS:

  1. hypersensitivity to the drug

WARNINGS

  • An immediate coagulant effect should not be expected after administration of vitamin K. Whole blood or component therapy is necessary if the patient is bleeding.
  • Repeated large doses of vitamin K are not warranted in liver disease if the response to initial use of the vitamin is unsatisfactory.
  • Failure to respond to vitamin K may indicate that the condition being treated is inherently unresponsive to vitamin K.

PRECAUTIONS

  • General: Allergic reactions can occur with IV administration
  • Laboratory Tests: No tests in addition to routine ICU tests are indicated
  • Drug/Laboratory Test Interactions:No tests additional to routine ICU tests are required.

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Temporary resistance to prothrombin-depressing anticoagulants may result, especially when larger doses of vitamin K are used. If relatively large doses have been employed, it may be necessary when re-instituting anticoagulant therapy to use somewhat larger doses of the prothrombin-depressing anticoagulant, or to use one which acts on a different principle, such as heparin.

ADVERSE REACTIONS

  • Body as a Whole: Transient “flushing sensations” and “peculiar” sensations of taste have been observed, as well as rare instances of dizziness, rapid and weak pulse, profuse sweating, brief hypotension. The possibility of allergic sensitivity, including an anaphylactoid reaction, should be kept in mind.
  • Respiratory System: Dyspnoea.
  • Local: Pain, swelling, and tenderness at the injection site may occur.

Critical Care Drug Manual

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