Parenteral administration of vitamin K1 can be followed by an anaphylactoid reaction. Vitamin K1 is poorly soluble in water so is formulated with an emulsifying agent.
Parenteral formulations of vitamin K1 can be administered intravenously (IV), intramuscularly (IM) or subcutaneously (SC). Absorption from intramuscular or subcutaneous injection may be erratic and unpredictable.
A small percentage of patients receiving parenteral vitamin K1 may experience an anaphylactoid reaction. Features of the anaphylactoid reaction:
(1) severe hypotension and shock
(2) bradycardia or tachycardia
(3) dyspnea
(4) bronchospasm
(5) cardiac arrest
(6) respiratory arrest
The anaphylactoid reaction appears to be most often associated with cremophor (polyoxyethylated caster oil, PEO-CO, polyoxyl caster oil) as the solubulizing agent. However, severe reactions may occur even when cremophor is not present.
Recommendations for safe administration of parenteral vitamin K1:
(1) Give vitamin K orally if possible.
(2) Ask about a history of anaphylactoid reaction to vitamin K or a drug containing cremophor.
(3) Take additional precautions if the patient has significant comorbid diseases.
(4) Use the formulation with mixed micelles as the emuslifying method if possible.
(5) Use the lowest effective dose.
(6) Dilute the drug if an intravenous infusion is being given.
(7) Administer the drug slowly.
(8) Closely monitor the patient during and after administration.
(9) Have resuscitation items readily available.