KETRODOL INJECTION

Indications

• Vitamin K deficiency
• Prophylaxis of vitamin K deficiency in newborns
• Management of anticoagulant-related bleeding
• Support in certain liver diseases affecting coagulation

Dosage

Children: Refer to the BNF for Children for specific dosing recommendations based on age and clinical condition.

Adults: Refer to the BNF for specific dosing recommendations based on indication and clinical status.

Mechanism of action

Phytometadione acts as a cofactor for the enzyme gamma-glutamyl carboxylase, which catalyzes the carboxylation of glutamic acid residues on vitamin K-dependent proteins. This post-translational modification is crucial for the activation of these proteins, enabling them to bind calcium ions, which is necessary for their biological activity in the coagulation cascade.

Pharmacodynamics

The pharmacodynamics of phytometadione are mainly related to its role in hemostasis. By facilitating the synthesis of clotting factors, it contributes to the regulation of blood coagulation. A deficiency in vitamin K can lead to an increased risk of bleeding due to impaired clot formation.

Pharmacokinetics

Phytometadione is absorbed in the intestines and is dependent on bile salts for its absorption. It is transported in the blood bound to lipoproteins and has a half-life of approximately 1 to 3 days. The liver is the primary site of its metabolism and storage. Excretion occurs primarily via bile and feces, with minimal renal elimination.

Contra-indications

• Hypersensitivity to phytomenadione or any of its excipients
• Severe liver disease
• Active thrombosis or thromboembolic disorders

Adverse effects

• Allergic reactions including rash, pruritus, and urticaria
• Gastrointestinal disturbances such as nausea and diarrhea
• Flushing
• Hypersensitivity reactions including anaphylaxis in rare cases

Interactions

• May interact with anticoagulants such as warfarin, leading to reduced efficacy of anticoagulation
• Certain antibiotics and anticonvulsants may affect vitamin K metabolism and reduce the effectiveness of phytomenadione
• Cholestyramine may reduce absorption of vitamin K

Precautions

• Monitor patients on anticoagulants closely when initiating treatment with phytomenadione
• Use caution in patients with liver impairment
• Evaluate for potential interactions with other medications that affect vitamin K metabolism

Pregnancy

Phytomenadione is generally considered safe during pregnancy, but should only be used if clearly needed. Consult with healthcare providers for individual assessment.

Breast-feeding

Phytomenadione is excreted in breast milk, but it is usually considered safe for use during breastfeeding. Consult with healthcare providers for individual assessment.

Storage

Store at room temperature, away from moisture and heat. Keep out of reach of children.

Formulations

• Injectable solution
• Oral tablets
• Oral liquid