Phytomenadione: Brands, Price & Uses in Bangladesh

Phytomenadione is a fat-soluble vitamin (Vitamin K1) used to prevent and treat bleeding problems that result from low levels of vitamin K-dependent clotting factors.

Established/Approved Uses

• Prevention of hemorrhagic disease of the newborn (HDN): routine prophylactic administration to newborns shortly after birth, as recommended by pediatric guidelines.
• Treatment of hemorrhagic disease of the newborn and vitamin K deficiency bleeding in infants.
• Hypoprothrombinemia caused by vitamin K deficiency or interference with vitamin K activity, including reversal of excessive anticoagulant effect of warfarin and other vitamin K antagonists (coumarin-type anticoagulants).
• Vitamin K deficiency due to malabsorption (e.g. biliary obstruction, celiac disease, cystic fibrosis, chronic diarrhea) or other conditions limiting vitamin K absorption/synthesis.

Adjunct / Supportive Use

• As part of supportive management in patients on prolonged broad-spectrum antibiotic therapy or parenteral nutrition who develop vitamin K deficiency.

Use of Phytomenadione should always be guided by a physician, particularly when it is being used to reverse anticoagulation, since this may affect ongoing anticoagulant therapy.

Dosing of Phytomenadione must be individualized by a physician based on the indication, severity, patient age, and response (guided by PT/INR monitoring where relevant).

Route of Administration

• Oral and intramuscular (IM)/subcutaneous (SC) routes are generally preferred.
• Intravenous (IV) administration should be reserved for situations where oral/IM/SC routes are not suitable, and must be given by slow IV injection/infusion (diluted, not as a rapid bolus), because rapid IV injection has been associated with rare but severe, sometimes fatal, anaphylactoid reactions. See Precautions and Warnings.

Renal/Hepatic Impairment

No specific dose adjustment is well established for renal impairment. In significant hepatocellular disease, response to Phytomenadione may be reduced because the liver's capacity to synthesize clotting factors is itself impaired; response should be monitored clinically and with coagulation tests.

Most side effects of Phytomenadione are mild and related to the injection site; serious reactions are rare but can occur, particularly with intravenous use.

• Common: pain, redness, swelling, or tenderness at the injection site (IM/SC use); a transient "peculiar" taste (oral).
• Uncommon: flushing, dizziness, or mild hypotension, more often reported with IV administration.
• Rare but serious: anaphylactoid/anaphylactic reactions (including flushing, chest tightness, dyspnea, cyanosis, hypotension, cardiac/respiratory arrest), reported particularly with rapid IV injection and occasionally fatal — see Precautions and Warnings.
• Rare (neonates): hyperbilirubinemia has been reported historically with high or repeated doses of vitamin K in newborns, particularly preterm infants.