Usage
- Menadione Sodium Bisulfite is prescribed for the prevention and treatment of vitamin K deficiency and hypoprothrombinemia (a deficiency of prothrombin, a clotting factor). It is also used to counteract the effects of excessive anticoagulant therapy. In veterinary medicine, it’s employed to prevent vitamin K deficiency in poultry and swine.
- Pharmacological Classification: Vitamin, Hemostatic agent.
- Mechanism of Action: Menadione, a synthetic analog of vitamin K, acts as a cofactor in the hepatic synthesis of essential blood clotting factors (II, VII, IX, and X) and anticoagulant proteins (C and S). It also plays a role in bone metabolism.
Alternate Names
- Menadione Sodium Bisulphite
- Vitamin K3 sodium bisulfite
- Synkayvite (brand name)
- Other brand names may exist regionally.
How It Works
- Pharmacodynamics: Menadione is crucial for synthesizing blood coagulation factors (II, VII, IX, X) and anticoagulant proteins (C and S) in the liver. This action promotes normal blood clotting and contributes to bone health.
- Pharmacokinetics:
- Absorption: The water-soluble menadione sodium bisulfite is readily absorbed from the gastrointestinal tract, even in the absence of bile salts.
- Metabolism: Primarily metabolized in the liver to more polar metabolites.
- Elimination: Excreted primarily in urine and bile as glucuronide and sulfate conjugates.
- Mode of Action: Menadione is converted to active vitamin K in the liver. It acts as a cofactor for the enzyme gamma-glutamyl carboxylase, which is essential for converting precursor proteins into functional clotting factors. This carboxylation reaction allows the clotting factors to bind calcium ions, which are necessary for their activation and participation in the coagulation cascade.
- Elimination Pathways: Primarily renal and hepatic excretion of metabolites.
Dosage
Standard Dosage
Adults:
- Vitamin K deficiency: 10 mg orally every 6 hours or 2.5–10 mg IM/IV daily.
- Hypoprothrombinemia: 10 mg orally 3–4 times daily or 2.5–10 mg IM/IV daily.
Children:
- Infants: 1–5 mcg/kg/day IV/Orally.
- Older children: Dosage should be individualized based on the severity of the deficiency.
- Pediatric Safety Considerations: Use with caution in neonates and premature infants due to the risk of hemolysis and hyperbilirubinemia.
Special Cases:
- Elderly Patients: Close monitoring of liver function is recommended. Dosage adjustments may be necessary.
- Patients with Renal Impairment: Dose adjustment based on creatinine clearance may be considered.
- Patients with Hepatic Dysfunction: Use with caution due to potential for worsening liver function. Dose reduction may be necessary.
- Patients with Comorbid Conditions: Use with caution in patients with G6PD deficiency due to the risk of hemolysis. Avoid use in neonates.
Clinical Use Cases
Dosage recommendations for specific clinical settings are not explicitly stated in the provided source material, and therefore are not included.
Dosage Adjustments
Dose modifications should be considered in patients with hepatic or renal impairment and G6PD deficiency. Close monitoring of prothrombin time is essential during therapy.
Side Effects
Common Side Effects
- Facial flushing
- Sweating
- Altered taste
- Injection site reactions (pain, swelling)
Rare but Serious Side Effects
- Hemolysis (destruction of red blood cells)
- Hypersensitivity reactions (anaphylaxis, skin rash, difficulty breathing)
- Cyanosis
- Cardiovascular collapse
Long-Term Effects
- Potential for liver damage with prolonged high doses
Adverse Drug Reactions (ADR)
- Anaphylaxis
- Severe hemolysis
- Kernicterus (brain damage in infants due to severe jaundice)
Contraindications
- Hypersensitivity to menadione or any component of the formulation
- G6PD deficiency
- Neonates and premature infants
- Severe liver disease (use with caution)
Drug Interactions
- Anticoagulants: Menadione antagonizes the effects of oral anticoagulants (e.g., warfarin). Close monitoring of prothrombin time and INR is crucial.
- Certain Antibiotics: Concomitant use with some antibiotics (e.g., aminoglycosides, erythromycin) can potentiate the anticoagulant effect and antagonize Vitamin K activity.
- Other Medications: Interactions with other medications metabolized by the liver are possible.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: C (consult a doctor)
- Fetal Risks: Although not considered highly teratogenic, there is some evidence of potential risk. Use only if clearly needed and under close medical supervision.
- Breastfeeding: Menadione is excreted in breast milk. Use with caution and monitor the infant for potential side effects.
Drug Profile Summary
- Mechanism of Action: Promotes hepatic synthesis of clotting factors.
- Side Effects: Facial flushing, sweating, altered taste, injection site reactions, hemolysis (rarely).
- Contraindications: G6PD deficiency, neonates.
- Drug Interactions: Oral anticoagulants.
- Pregnancy & Breastfeeding: Use with caution.
- Dosage: Varies depending on indication and patient factors.
- Monitoring Parameters: Prothrombin time, liver function tests.
Popular Combinations
Combination information is not explicitly available in the sources provided.
Precautions
- General Precautions: Screen for G6PD deficiency and liver disease before administration. Monitor liver function and prothrombin time.
- Specific Populations:
- Pregnant Women: Use only if clearly needed and under close supervision.
- Breastfeeding Mothers: Use with caution and monitor infant.
- Children & Elderly: Close monitoring is essential, especially in neonates and individuals with liver disease.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Menadione Sodium Bisulfite?
A: Dosage depends on the condition being treated. For adults, the typical dose for vitamin K deficiency is 10 mg orally every 6 hours. For hypoprothrombinemia, it is 10 mg orally 3-4 times a day. Infants can be given 1-5 mcg/kg/day. Dosages should be adjusted for patients with hepatic/renal impairment.
Q2: How is Menadione Sodium Bisulfite administered?
A: It can be administered orally, intramuscularly (IM), or intravenously (IV).
Q3: What are the primary uses of this medication?
A: Primarily used to treat and prevent vitamin K deficiency, hypoprothrombinemia, and reverse the effects of excessive anticoagulant therapy.
Q4: What are the significant drug interactions with Menadione Sodium Bisulfite?
A: It interacts significantly with oral anticoagulants like warfarin, reducing their efficacy. Some antibiotics may also interact.
Q5: What precautions should be taken when prescribing this drug to pregnant or breastfeeding women?
A: Menadione should be used cautiously during pregnancy and breastfeeding. It is essential to weigh the potential benefits against the risks to the fetus or infant. Consult a specialist if necessary.
Q6: What are the common side effects patients might experience?
A: Common side effects include facial flushing, sweating, altered taste, and injection site reactions.
Q7: Are there any contraindications for this drug?
A: Yes, contraindications include G6PD deficiency, hypersensitivity to the drug, and use in neonates.
A: Menadione (K3) is a synthetic, water-soluble analog of vitamin K, while vitamin K1 (phylloquinone) and vitamin K2 (menaquinone) are naturally occurring. Menadione requires conversion to an active form in the liver. Vitamin K1 and K2 are preferred for newborns due to the risk of hemolysis associated with K3.
Q9: What should I monitor in a patient taking Menadione Sodium Bisulfite?
A: Monitor prothrombin time/INR regularly, especially if the patient is also on anticoagulants. Liver function tests should also be conducted periodically, especially in long-term use or in patients with pre-existing liver conditions.
