KONAKION MM Solution (ampoules) Ref.[7155] Active ingredients: Vitamin K1

Konakion MM ampoules are for i.v. injection.

Adults

Severe or life-threatening haemorrhage, e.g. during anticoagulant therapy

The coumarin anticoagulant should be withdrawn and an intravenous injection of Konakion MM given slowly (over at least 30 seconds) at a dose of 5-10 mg together with prothrombin complex concentrate (PCC).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 Konakion MM 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 Konakion MM Paediatric (2 mg/0.2 ml: 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 Konakion MM. The dosage for this patient group should therefore be at the lower end of the ranges recommended.

Instructions for infusion in adults

Konakion MM Ampoules are for intravenous injection and should be diluted with 55ml of 5% glucose before slowly infusing the product. The solution should be freshly prepared and protected from light. Konakion MM Ampoule solution should not be diluted or mixed with other injectables, but may be injected into the lower part of an infusion apparatus.

Children aged 1 to 18 years

It is advisable that a haematologist is consulted about appropriate investigation and treatment in any child in whom Konakion MM 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 Konakion MM 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 i.v. 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

Konakion MM Paediatric 2 mg/0.2 ml should be used in these patients (see separate prescribing information).

Hypervitaminosis of vitamin K₁ is unknown.

Reintroduction of anti-coagulation may be affected.

Shelf life: The recommended shelf-life of Konakion MM Ampoules is 36 months.

The recommended maximum storage temperature is 25°C. Do not use if the solution is turbid.

Konakion MM is supplied in amber glass ampoules containing 10mg phytomenadione in 1ml. The ampoule solution is clear to slightly opalescent, pale yellow in colour and contains the active constituent in a mixed micelles vehicle of glycocholic acid and lecithin.

See Section 4.2.