Dosing & UsesDosage Forms & Strengths Recommended daily intake (RDA) Males: 120 mcg/day PO Females: 90 mcg/day PO Hypoprothrombinemia Due To Drugs or Factors Limiting Absorption or Synthesismay be increased PRN to 25 mg or, rarely, to 50 mg; may be repeated in 12-48 hours Reversal of Warfarin Effects Omit 1-2 doses, or hold warfarin; monitor INR and adjust warfarin dose accordingly INR 4.5-10, no bleeding: 2012 ACCP guidelines suggest against routine use; 2008 ACCP guidelines suggest considering vitamin K1 (phytonadione) 1-2.5 mg PO once INR >10, no bleeding: 2012 ACCP guidelines recommend vitamin K1 PO (dose not specified); 2008 ACCP guidelines suggest 2.5-5 mg PO once; INR reduction observed within 24-48 hr, monitor INR and give additional vitamin K if needed Minor bleeding, any elevated INR: Consider 2.5-5 mg PO once; may repeat if needed after 24 hr Major bleeding, any elevated INR: 2012 ACCP guidelines recommend prothrombin complex concentrate, human (PCC, Kcentra) plus vitamin K1 5-10 mg IV (dilute in 50 mL IV fluid and infuse over 20 min)
NOTE: High vitamin K doses (ie, 10 mg or more) may cause warfarin resistance for a week or more; consider using heparin, LMWH, or direct thrombin inhibitors to provide adequate thrombosis prophylaxis in clinical conditions requiring chronic anticoagulation therapy (eg, atrial fibrillation) PO dose may be repeated in 12-48 hr and SC/IV/IM dose in 6-8 hr if necessary IV rate not to exceed 1 mg/min Use of high vitamin K doses (10-15 mg) may cause warfarin resistance for ≥1 week Dosage Forms & Strengths 0-6 months: 2 mcg/day 6-12 months: 2.5 mcg/day 1-3 years: 30 mcg/day 4-8 years: 55 mcg/day 9-13 years: 60 mcg/day 14-18 years: 75 mcg/day Hemorrhagic Disease of the Newborn Prophylaxis: 0.5-1 mg IM within 1 hr of birth Treatment: 1 mg/dose/day SC; my require higher doses if mother has been receiving oral anticoagulants InteractionsInteraction CheckerEnter a drug nameNo Results ContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorSeverityName
Anaphylaxis with too-rapid IV administration (has resulted in death) Hyperbilirubinemia (in premature neonates) Severe reactions, including fatalities, have occurred during and immediately after IV administration, even when precautions have been taken with proper dilution and avoidance of rapid infusion Severe reactions also reported after IM administration; typically, these severe reactions involve hypersensitivity or anaphylaxis and include shock and cardiac or respiratory arrest IV/IM reactions may occur with first dose (no prior exposure to phytonadione) Restrict use of IV/IM routes to situations where SC administration is not feasible and serious risk involved is considered justified Rapid IV administration may cause potentially fatal anaphylaxisagent is rapidly degraded Avoid IM route if patients is bleeding or in 3rd trimester of pregnancy Administer phtonadione to quickly lower INR into safe range in patients receiving vitamin K antagonists
Other forms of vitamin K (eg, menadione) are not effective in these settings; only vitamin K1 (ie, phytonadione) should be used Time of onset depends on rate of synthesis of clotting factors Inefective in hereditary hypoprothrombinemia Longer treatment durations (up to months) and much higher doses required in patients exposed to long-acting anticoagulant rodenticide Hemolysis, hyperbilirubinemia, and jaundice reported in newborns treated with larger than recommended doses; Lactation: Excreted in breast milk; Controlled studies in pregnant women show no evidence of fetal risk.Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Promotes hepatic synthesis of clotting factors II, VII, IX, X (exact mechanism is unknown) Onset: 6-10 hr (PO); Peak effect: 24-48 hr (PO); Dilute in preservative-free NS, D5W, or D5NS and infuse slowly; infusion rate not to exceed 1 mg/min IV route should be used only if administration by another route is not feasible Protect injection emulsion from light at all times FormularyAdding plans allows you to compare formulary status to other drugs in the same class.To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.Create Your List of PlansAdding plans allows you to:View the formulary and any restrictions for each plan.pare formulary status to other drugs in the same class.Access your plan list on any device – mobile or desktop. The above information is provided for general informational and educational purposes only.
Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. This drug is available at the lowest co-pay. commonly, these are generic drugs. This drug is available at a middle level co-pay. commonly, these are "preferred" (on formulary) brand drugs. This drug is available at a higher level co-pay. commonly, these are "non-preferred" brand drugs. commonly, these are "non-preferred" brand drugs or specialty NOT COVERED – Drugs that are not covered by the plan. Prior Authorization Drugs thatThis restriction requires that specific clinical criteria be met prior to the approval of the Quantity Limits Drugs that have quantity limits associated with each prescription. restriction typically limits the quantity of the drug that will Step Therapy Drugs that have step therapy associated with each prescription. typically requires that certain criteria be met prior to