vitamin-k-1 and Drug-Hypersensitivity

Parenteral vitamin K1 (phytonadione) is used for anticoagulant reversal, and a boxed warning exists with intravenous and intramuscular administration due to the possibility of severe reactions, including fatalities. These reactions resemble hypersensitivity or anaphylaxis, including anaphylactoid reaction, and have led to shock and cardiac and/or respiratory arrest. The objective of this review is to summarize the available literature detailing the anaphylactic/anaphylactoid reactions with parenteral vitamin K1 in order to better characterize the reaction and provide a more in-depth understanding of its importance. A comprehensive literature search of MEDLINE (1946 to June 2016) and EMBASE (1947 to June 2016) was conducted using the terms vitamin K1, phytonadione, phytomenadione, vitamin K group, anaphylaxis, polyoxyethylated castor oil, and cremophor. A total of 2 retrospective surveillance studies, 2 retrospective cohort studies, and 17 case reports were identified for inclusion and assessment. Based on a review of the literature, use of parenteral vitamin K1 may result in severe hypotension, bradycardia or tachycardia, dyspnea, bronchospasm, cardiac arrest, and death. These reactions are most consistent with a nonimmune-mediated anaphylactoid mechanism. It appears that intravenous administration is more frequently associated with these reactions and occurs at an incidence of 3 per 10 000 doses of intravenous vitamin K1. The solubilizer may also increase the risk of adverse reactions, which occurred in patients with and without previous exposure to vitamin K1. Although there are known factors that increase the risk of an adverse drug event occurring, reactions have been reported despite all precautions being properly followed.

Topics: Anaphylaxis; Anticoagulants; Antidotes; Drug Hypersensitivity; Female; Humans; Male; Vitamin K 1

Skin reactions after vitamin K injections are uncommon and only seen with vitamin K1 (phytomenadione). Possible association with liver disease is debated. The pathophysiological mechanism would be related to hypersensitivity to phytomenadione.. Two new cases of hypersensitivity reactions at the point of vitamin K1 injection are reported. Neither of the patients had liver disease.. Injectable vitamin K1 can cause skin reactions whatever the dose and mode of injection. Two clinical presentations have been described: an acute eczematous aspect and a late onset sclerous and atrophic form. The first cases of hypersensitivity to vitamin K were reported in patients with liver disease. Several recent publications did not find such an association. Our two observations would confirm this hypothesis. The pathophysiological mechanism of the acute form would involve type IV allergy to phytomenadione as suggested by the delay between sensitization and reactivation, the histology, the patch tests which are positive with phytomenadione and negative with the carrier and the presence of reaction at rechallenge. However, the lack of the necessary sensitization phase and abnormally slow regression of eczematous lesions are unusual and might be explained by a particularly active antigenic effect of the phytomenadione molecule possibly related to the phytyl moiety.

Topics: Adult; Antifibrinolytic Agents; Drug Hypersensitivity; Female; Humans; Injections, Intramuscular; Middle Aged; Vitamin K 1

Vitamin K1 is frequently used in the treatment and prevention of hypoprothrombinemia and hemorrhagic disease of the newborn. It also serves as an antidote to anticoagulants. Erythematous, indurated, pruritic plaques uncommonly occur in adults after intramuscular injection with vitamin K1. We present a case of a localized cutaneous reaction to intramuscular vitamin K1 in a peripartum patient with acute fatty liver of pregnancy. The history and clinical presentation of our case is presented with a discussion of the pathogenesis pathogenesis of vitamin K1 and available treatment for this condition.

Topics: Acute Disease; Drug Eruptions; Drug Hypersensitivity; Eczema; Erythema; Fatty Liver; Female; Humans; Hypoprothrombinemias; Injections, Intramuscular; Pregnancy; Pregnancy Complications; Puerperal Disorders; Vitamin K 1; Young Adult

Topics: Adverse Drug Reaction Reporting Systems; Animals; Anticoagulants; Antifibrinolytic Agents; Dog Diseases; Dogs; Drug Hypersensitivity; Drug Labeling; Humans; Injections, Intravenous; Poisoning; Rodenticides; United States; United States Food and Drug Administration; Vitamin K 1; Warfarin

Topics: Adult; Anaphylaxis; Cyclosporine; Drug Hypersensitivity; Female; Humans; Immunosuppressive Agents; Injections, Intravenous; Injections, Subcutaneous; Vitamin K 1

Topics: Dermatitis, Atopic; Drug Eruptions; Drug Hypersensitivity; Erythema; Humans; Hypersensitivity, Immediate; Injections, Subcutaneous; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Vitamin K 1

A 63-year old man developed a delayed cutaneous reaction at the sites of intramuscular injections of a phytonadione (vitamin K) preparation. The patient was tested with the drug and its components by intradermal and epicutaneous application. Sensitivity to the pure phytonadione and not the other components of the preparation was documented by patch tests.

Topics: Drug Hypersensitivity; Humans; Hypersensitivity, Delayed; Injections, Intramuscular; Male; Middle Aged; Vitamin K 1