What is phytomenadione used for?
phytomenadione is evaluated for the following indications with varying evidence strength: Coagulopathy in cholestasis and malabsorption (evidence tier A), Reversal of warfarin anticoagulant effect (evidence tier A), Vitamin K deficiency bleeding (VKDB) prevention in newborns (evidence tier A). See the full indication matrix with dosing and citations above on this page.
What are the side effects of phytomenadione?
Common side effects of phytomenadione (≥ 1 in 100): Injection-site pain and erythema, Facial flushing, sensation of warmth (after intravenous administration). See the Safety section for uncommon and serious reactions.
Is phytomenadione safe during pregnancy?
FDA category C. FDA category C. Used in pregnancy for anticoagulant- or deficiency-related coagulopathy. Phytomenadione transfers across the placenta poorly, so newborn prophylaxis via maternal third-trimester intake is less effective than post-delivery injection of the infant.
Is phytomenadione compatible with breastfeeding?
Breast milk contains little vitamin K (1–4 µg/L), so maternal K1 intake is insufficient to prevent VKDB in the infant. Standard practice: direct K1 injection to the newborn. Maternal K1 intake is compatible with breastfeeding.
Who should not take phytomenadione?
phytomenadione is contraindicated in: Hypersensitivity to phytomenadione; Severe hepatic failure with markedly reduced synthetic function (K1 effect is minimal). Full list in the Safety section.
the vitamin K shot at birth is unnecessary, you can refuse or use drops
intramuscular K1 1 mg in the first hours of life is the unanimous recommendation of AAP, NICE, WHO, and Russian normal-pregnancy guidelines. Without prophylaxis, the late VKDB risk with intracranial haemorrhage is 4–7 per 100,000 live births. Oral regimens are acceptable when injection is refused but are less effective.
Vikasol can be given to an infant instead of K1
Vikasol is K3 (menadione sodium bisulfite), a synthetic molecule. In newborns, K3 causes haemolytic anaemia and kernicterus risk. AAP, ESPGHAN, and NICE explicitly state that only K1 (phytomenadione) is used for VKDB. International paediatric practice has not used K3 for decades. Russian package inserts still list Vikasol as a «vitamin K» drug – this is outdated practice.
vitamin K at birth is linked to childhood leukaemia
this hypothesis came from a single Golding et al. 1992 paper. Subsequent large epidemiological studies (Roman 2002, Fear 2003, McKinney 2003) did not confirm the association. AAP in its position statement explicitly rejects the hypothesis. Refusing K1 prophylaxis based on this myth raises real VKDB risk.
K1 and K2 are interchangeable – they are just vitamins K
different molecules, different target tissues, different indications. K1 (phytomenadione) acts on hepatic clotting factors – the only form for VKDB and warfarin reversal. K2 (menaquinone) acts on tissue Gla proteins – marketed for bones and vessels with weak clinical basis. They do not substitute for each other across indications.
extra K1 in adults improves clotting
in a healthy adult, vitamin K is not deficient and clotting factors synthesise normally. Supplemental K1 without a clinical indication has no effect. In patients on warfarin, supplemental K1 is dangerous – it disrupts anticoagulation.