Haemokion/ Phytomenadione 10 mg/1 ml is indicated as an antidote to anticoagulant drugs of the coumarin type in the treatment of haemorrhage or threatened haemorrhage, associated with a low blood level of prothrombin or factor VII..

Doses and mode of administration for adults and, where applicable, for children and/or elderly:

Haemokion /Phytomenadione 10 mg/1 ml is for intravenous injection.

Adults

Severe or life-threatening haemorrhage, e.g. during anticoagulant therapy: The coumarin anticoagulant should be withdrawn and an intravenous injection of Haemokion /Phytomenadione 10 mg/1 ml given slowly (over at least 30 seconds) at a dose of 5-10 mg together with prothrombin complex concentrate (PCC). Fresh frozen plasma (FFP) may be used if PCC is not available. The patient's INR should be estimated three hours later and, if the response has been inadequate, the dose should be repeated. Not more than 40 mg of Haemokion /Phytomenadione 10 mg/1 ml should be given intravenously in 24 hours. Coagulation profiles must be monitored on a daily basis until these have returned to acceptable levels; in severe cases more frequent monitoring is necessary.

Dose recommendations for vitamin K1 therapy in patients with major and life-threatening bleeding:

PCC, prothrombin complex concentrate

1 Fresh frozen plasma (FFP) may be used if PCC is not available

Less severe haemorrhage:

Treatment of asymptomatic patients with elevated INR values depends on factors such as the underlying indication for anticoagulation, INR value, length of time spent outside the therapeutic INR range, patient characteristics (e.g. age, comorbidity, concomitant medication), and the associated risk of major bleeding. The following dose recommendations are provided for therapeutic guidance only:

Dose recommendations for vitamin K1 therapy in patients with asymptomatic high International Normalised ratio (INR) with or without mild haemorrhage:

For small doses one or more ampoules of Haemokion / Phytomenadione 2 mg/0.2 ml solution for injection (same solution) can be used.

Reversal of anticoagulation prior to surgery

Patients who require emergency surgery that can be delayed for 6-12 hours can be given 5 mg intravenous vitamin K1 to reverse the anticoagulant effect. If surgery cannot be delayed, PCC can be given in addition to intravenous vitamin K1 and the INR checked before surgery.

Use with anticoagulants other than warfarin

The dosing recommendations above apply to patients taking warfarin. There are limited data regarding reversal of the effects of other anticoagulants, such as acenocoumarol or phenprocoumon. The half-lives of these anticoagulants are different to warfarin and different doses of vitamin K1 may be required.

Special dosage instructions

Elderly

Elderly patients tend to be more sensitive to reversal of anticoagulation with Haemokion /Phytomenadione 10 mg/1 ml. The dosage for this patient group should therefore be at the lower end of the ranges recommended.

Instructions for infusion in adults

the product should not be diluted or mixed with other parenteral medications, but where appropriate may be injected into the lower chamber of an i.v. giving set during continuous infusion of 0.9% sodium chloride or 5% glucose.

Children aged 1 to 18 years

It is advisable that a haematologist is consulted about appropriate investigation and treatment in any child in whom Haemokion /Phytomenadione 10 mg/1 ml is being considered.

Likely indications for using vitamin K in children are limited and may include:

1. Children with disorders that interfere with absorption of vitamin K (chronic diarrhoea, cystic fibrosis, biliary atresia, hepatitis, coeliac disease).

2. Children with poor nutrition who are receiving broad spectrum antibiotics.

3. Liver disease.

4. Patients receiving anticoagulant therapy with warfarin in whom the INR is increased outside the therapeutic range and therefore are at risk of, or are bleeding, and those with an INR in the therapeutic range who are bleeding.

For patients on warfarin therapy, therapeutic intervention must take into consideration the reason for the child being on warfarin and whether or not anticoagulant therapy has to be continued (e.g. in a child with mechanical heart valve or repeated thromboembolic complications) as vitamin K administration is likely to interfere with anticoagulation with warfarin for 2-3 weeks.

It should be noted that the earliest effect seen with vitamin K treatment is at 4-6 hours and therefore in patients with severe haemorrhage replacement with coagulation factors may be indicated (discuss with haematologist).

Dose of vitamin K

There are few data available regarding use of this medicine in children over 1 year. There have been no dose ranging studies in children with haemorrhage. The optimal dose should therefore be decided by the treating physician according to the indication, clinical situation and weight of the patient. Suggested dosages based on clinical experience are as follows:

Children with major and life-threatening bleeding

A dose of 5 mg vitamin K1 IV is suggested (together with PCC if appropriate, or FFP if PCC is not available).

Children with asymptomatic high International Normalised Ratio (INR) with or without mild haemorrhage

Intravenous vitamin K1 at doses of 30 micrograms/kg have been reported to be effective in reversing asymptomatic high (>8) INR in clinically well children.

The patient's INR should be measured 2 to 6 hours later and if the response has not been adequate, the dose may be repeated. Frequent monitoring of vitamin K dependent clotting factors is essential in these patients.

Neonates and babies

Haemokion Paediatric/Phytomenadione 2 mg/0.2 ml solution for injection should be used in these patients (see separate prescribing information).

When treating patients with severely impaired liver function, it should be borne in mind that one 1 ml ampoule of Haemokion /Phytomenadione 10 mg/1 ml contains 54.6 mg glycocholic acid and this may have a bilirubin displacing effect. Careful monitoring of the INR is necessary after administration of this medicine in patients with severely impaired liver function.

At the time of use, the ampoule contents should be clear. Following incorrect storage, the contents may become turbid or present a phase separation. In this case the ampoule must no longer be used.

In potentially fatal and severe haemorrhage due to overdosage of coumarin anticoagulants, intravenous injections of Haemokion /Phytomenadione 10 mg/1 ml must be administered slowly and not more than 40 mg should be given during a period of 24 hours. Haemokion /Phytomenadione 10 mg/1 ml therapy should be accompanied by a more immediate effective treatment such as transfusion of whole blood or blood clotting factors. When patients with prosthetic heart valves are given transfusions for the treatment of severe or potentially fatal haemorrhage, fresh frozen plasma should be used. The use of vitamin K1 in patients with mechanical heart valves is generally to be avoided, unless there is major bleeding.

Large doses of Haemokion /Phytomenadione 10 mg/1 ml (not more than 40 mg per day) should be avoided if it is intended to continue with anticoagulant therapy because there is no experience with doses above this maximum of 40 mg per day and higher doses may give rise to unexpected adverse events. Clinical studies have shown a sufficient decrease in the INR with the recommended dosage. If haemorrhage is severe, a transfusion of fresh whole blood may be necessary whilst awaiting the effect of the vitamin K1.

Vitamin K1 is not an antidote to heparin.

No significant interactions are known other than antagonism of coumarin anticoagulants.

There is no specific evidence regarding the safety of Phytomenadione in pregnancy but, as with most drugs, the administration during pregnancy should only occur if the benefits outweigh the risks.
This medicine is not recommended for pregnant women as prophylaxis of vitamin K deficiency bleeding in the newborn.

None

There have been reports of anaphylactoid reactions after intravenous injections of this medicine.

Very rarely, venous irritation or phlebitis has been reported in association with intravenous administration of Phytomenadione 10 mg/1 ml mixed micelles solution.

Hypervitaminosis of vitamin K1 is unknown.
Reintroduction of anti-coagulation may be affected.

Pharmacotherapeutic group: Antihaemorrhagics (vitamins), ATC code B02BA01.
Phytomenadione 10 mg/1 ml is a synthetic preparation of vitamin K. The presence of vitamin K (i.e. vitamin K or substances with vitamin K activity) is essential for the formation within the body of prothrombin, factor VII, factor IX and factor X. Lack of vitamin K leads to an increased tendency to haemorrhage. When an antidote to an anticoagulant is necessary it is essential to use vitamin K1 itself, as vitamin K analogues are much less effective.
In the mixed micelles solution, vitamin K1 is solubilised by means of a physiological colloidal system, also found in the human body, consisting of lecithin and bile acid. Owing to the absence of organic solvents, Phytomenadione 10 mg/1 ml mixed micelles solution is well tolerated on intravenous administration.

In blood plasma, 90% of vitamin K1 is bound to lipoproteins. Following an intramuscular dose of 10 mg vitamin K, plasma concentrations of 10-20 mcg/l are produced (normal range 0.4-1.2 mcg/l). Systemic availability following intramuscular administration is about 50% and elimination half-life in plasma is approximately 1.5-3 hours.

Not Applicable 

No Data available

Store at a temperature not exceeding 25 °C protect from light

Carton Box containing contains 3 amber glass (Type I) ampoules each ampoule contains 1 ml solution and inner leaflet

Not Applicable