Kenadion Injection
✅ Aids blood clotting
✅ Prevents bleeding
✅ Treats vitamin K deficiency
✅ Supports bone health
✅ Essential for newborns
Kenadion Injection contains Vitamin K.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
Quick Answer
Kenadion Injection (phytomenadione (vitamin K1) 10 mg ampoule) is vitamin K1 (phytomenadione) for IV or IM injection. It is used as the antidote in warfarin overdose, to prevent and treat haemorrhagic disease of the newborn, and in vitamin K deficiency from malabsorption or cholestasis.
- Phytomenadione (vitamin K1) 10 mg per ampoule
- Indications: warfarin reversal, neonatal vitamin K prophylaxis, malabsorption-related deficiency
- IV (slow) or IM administration — specialist setting
- WHO-GMP certified manufacturer
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What is Kenadion Injection?
Kenadion is parenteral phytomenadione (vitamin K1) — the natural form of vitamin K essential for hepatic synthesis of clotting factors II, VII, IX, X, and proteins C and S. Vitamin K1 is the antidote in warfarin overdose, the routine prophylaxis given to newborns to prevent haemorrhagic disease of the newborn, and the replacement therapy for vitamin K deficiency caused by chronic malabsorption or biliary obstruction.
Indications
- Warfarin overdose / over-anticoagulation — INR-driven dose
- Vitamin K deficiency bleeding (VKDB) of the newborn — routine 1 mg IM at birth (or oral 2 mg at birth and follow-up doses)
- Vitamin K deficiency from malabsorption — coeliac disease, inflammatory bowel disease, cystic fibrosis, short-bowel
- Cholestatic liver disease — biliary obstruction prevents bile-salt-dependent fat-soluble vitamin absorption
- Chronic broad-spectrum antibiotic use — gut flora destroyed, vitamin K2 production lost
- Total parenteral nutrition without adequate vitamin K supplementation
- Pre-procedural reversal in warfarinised patients (alongside 4F-PCC for emergency reversal)
Rapid IV phytomenadione has caused fatal anaphylactoid reactions (especially with the older Cremophor-containing formulations). Modern emulsion formulations are safer, but IV vitamin K1 must be given slowly — over at least 30 seconds for small doses, ideally as a 30-minute infusion in 50 ml saline for higher doses. IM is generally safer than IV but slower in onset.
| Indication | Dose & route | Onset |
|---|---|---|
| Neonatal VKDB prophylaxis | 1 mg IM at birth (or 2 mg oral at birth + follow-up) | Hours |
| Warfarin INR > 8 (no bleeding) | 1–5 mg oral or 0.5–1 mg slow IV | IV: 6–12 hours; oral: 24 hours |
| Warfarin major bleeding | 5–10 mg slow IV + 4F-PCC | IV: 6–12 hours (PCC: minutes) |
| Vitamin K deficiency, established | 5–10 mg IV/IM, may repeat | 6–12 hours |
| Cholestatic disease maintenance | 10 mg IM monthly (or oral phytomenadione daily) | Hours-to-days |
| TPN supplementation | Per parenteral nutrition protocol | Maintenance |
Side effects
- Anaphylactoid reaction with rapid IV — the dominant safety concern; mandatory slow administration
- Injection site discomfort
- Hypersensitivity reaction — rare but reported
- Warfarin resistance — high-dose K1 may make subsequent re-anticoagulation harder; smaller doses preferred when bridging is anticipated
Drug interactions
- Warfarin — vitamin K1 reverses anticoagulation; this is intentional in overdose but problematic if anticoagulation is therapeutically needed. Choose dose carefully when reversing.
- Other vitamin K antagonists (acenocoumarol, phenprocoumon) — same antagonism
- Direct oral anticoagulants (apixaban, rivaroxaban, dabigatran) — vitamin K1 has NO effect on these; reversal needs different agents (andexanet, idarucizumab, 4F-PCC)
Contraindications
- Hypersensitivity to phytomenadione
- Caution in severe hepatic impairment (response may be limited if hepatic synthesis itself is failing)
Storage
Store below 25°C, protect from light. Use ampoule once opened.
Frequently Asked Questions
Why is it given to newborns?
Newborns are vitamin K-deficient at birth (poor placental transfer, sterile gut at birth, low K1 in breast milk). Vitamin K deficiency bleeding (VKDB) of the newborn was a major cause of catastrophic intracranial bleeding before routine prophylaxis. WHO and national guidelines recommend 1 mg IM at birth (or oral 2 mg at birth followed by additional doses); IM is more reliable than oral for prevention.
Why is rapid IV dangerous?
Older Cremophor-containing formulations of phytomenadione caused anaphylactoid reactions (acute hypotension, bronchospasm, rarely fatal). Modern aqueous-emulsion formulations are safer but slow administration is still mandatory. Where possible, oral or IM is preferred.
How does it reverse warfarin?
Warfarin blocks vitamin-K-epoxide reductase in the liver, preventing recycling of reduced vitamin K needed to gamma-carboxylate clotting factors II, VII, IX, X. Phytomenadione bypasses this block by providing reduced vitamin K1, allowing fresh clotting factor synthesis. Onset is hours-to-days; emergency reversal needs 4F-PCC for the immediate factor replacement.
Will it work for DOAC bleeding?
No. Apixaban, rivaroxaban, edoxaban, dabigatran do NOT involve vitamin K. Phytomenadione has no effect on them. Reversal needs andexanet alfa (Xa inhibitors) or idarucizumab (dabigatran), with 4F-PCC as backup.
Can patients on warfarin take vitamin K?
Vitamin K-rich foods (leafy greens, broccoli) are not forbidden — the rule is consistency. Patients on warfarin should keep vitamin K intake stable so the warfarin dose can be matched. Sudden multivitamin starts/stops or major dietary swings cause INR instability. Multivitamins with vitamin K should be discussed with the warfarin clinic.
How quickly does INR drop after vitamin K?
Oral vitamin K1: INR begins falling at 6–12 hours, normalises by 24–48 hours. IV vitamin K1: faster, INR begins falling at 6–12 hours. Emergency reversal (active bleeding) needs 4F-PCC for immediate factor replacement — vitamin K is supportive but slow.
Is it safe in pregnancy?
Yes — commonly given in malabsorption / cholestasis-of-pregnancy. Crosses placenta poorly so does not cause fetal effects acutely.
Why does cholestatic liver disease cause vitamin K deficiency?
Vitamin K is fat-soluble. Bile salts are needed for fat absorption. Biliary obstruction (gallstone, primary biliary cholangitis, cholangiocarcinoma) blocks bile flow, preventing fat-soluble vitamin absorption. Vitamin K deficiency causes elevated INR even before clinical bleeding.
Can I take vitamin K orally instead?
Yes — oral phytomenadione tablets exist for non-emergency replacement (e.g. cholestatic-disease maintenance, mild warfarin over-anticoagulation without bleeding). The injection is for emergencies, neonatal prophylaxis, severe malabsorption, or when oral cannot be tolerated.
Will it interact with my other medicines?
Mainly warfarin and other vitamin K antagonists. No clinically significant interactions with most other drugs — including antibiotics, statins, antihypertensives, or oral contraceptives.
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Medical Disclaimer
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| Strength | 10mg/1ml |
|---|---|
| Quantity | 5 Ampoule/s, 10 Ampoule/s, 15 Ampoule/s, 25 Ampoule/s |
Kenadion Injection
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