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Uses of Tonadione


Tonadione has the main ingredient Phytomenadion with a concentration of 10mg/1ml. The drug is used in the prevention and treatment of hypoprothrombinemia due to the use of oral anticoagulants; Prevention and treatment of bleeding due to vitamin K deficiency. The following article provides readers with information about the uses and precautions when using Tonadione.

1. Uses of Tonadione


Tonadione drug has the main ingredient Phytomenadion (vitamin K1), the drug is prepared in the form of an injectable emulsion.
Phytomenadion (phytonadion) also known as fat-soluble vitamin K1. Phytomenadion is a natural vitamin K, found in meat, egg yolk, cow's milk, green vegetables (cabbage) and some cereals, while phytonadion is synthesized.
Minimum daily vitamin K requirement has not been determined, around 1mcg/kg may be sufficient. The vitamin K requirement in healthy adults can be met from the diet and from bacterial synthesis of menaquinone (vitamin K2) in the gut.
Vitamin K deficiency can occur in children with fat malabsorption, especially when the patient has cholestasis or severe liver failure. Newborns are often susceptible to vitamin K deficiency and are at risk of bleeding (intraventricular) if not supplemented. Adults are very rarely vitamin K deficient, except in the presence of fat malabsorption syndrome, biliary obstruction, jaundice.
Vitamin K deficiency reduces blood prothrombin, leading to prolonged clotting time and spontaneous bleeding. Vitamin K is necessary for the liver to synthesize clotting factors such as prothrombin (factor II); factors VII, IX and X; Protein C and S.
Phytomenadion is used to treat hypoprothrombinemia and bleeding caused by vitamin K deficiency and the use of coumarin anticoagulant therapy. Phytomenadion is used as an antidote to an overdose of coumarin or warfarin-type anticoagulants.
Phytomenadion has no immediate effect, even if administered intravenously. Phytomenadion acts faster and lasts longer than Menadion.

2. Indications and contraindications to the use of Tonadione


2.1. Indications Tonadione is indicated in the following cases:
Prophylaxis and treatment of hypoprothrombinemia due to the use of oral anticoagulants (vitamin K antagonists). Prevention and treatment of bleeding due to vitamin K deficiency: caused by the body's inability to absorb vitamin K (malabsorption syndrome, biliary obstruction); use of drugs that cause vitamin K deficiency such as long-term broad-spectrum antibiotic therapy (which destroys the microflora that can only synthesize vitamin K in the intestine). 2.2. Contraindications Contraindicated to use Tonadione drug in case the patient is hypersensitive to Phytomenadion or any ingredient of the drug. Tonadione should not be used intramuscularly in patients at high risk of bleeding.

3. Some notes when using the drug Tonadione


Tonadione can cause hemolysis in patients with glucose - 6 - phosphate dehydrogenase deficiency. When used in high doses in patients with severe liver disease, further deterioration of liver function may occur. The dose of Tonadione for newborns should not exceed 5mg/day in the first few days of life due to immature liver enzyme systems. The polyethoxyd castor oil contained in phytomenadion injections may cause severe anaphylactoid reactions in patients. This castor oil when used for a long time to patients can also produce abnormal lipoproteins, change blood viscosity and red blood cell aggregation. In the case of patients with severe bleeding, the effect of the drug will be slow regardless of the route of administration, hence the need for transfusion of whole blood or transfusion of blood components. Pregnant women: Phytomenadion crosses the placenta sparingly. Phytomenadion is not toxic when used at doses < 20 mg. Therefore, phytomenadion is the drug of choice for the treatment of maternal hypoprothrombinemia and the prevention of neonatal haemorrhage. Vitamin K supplementation for pregnant women is not necessary, unless the mother is at risk of vitamin K deficiency. A daily menu during pregnancy should contain 45mcg Phytomenadion. Lactation: Phytomenadion levels in breast milk are usually low. Most milk samples contained < 20 nanogram/ml, many samples < 5 nanogram/ml. Although not all, many newborns are vitamin K deficient due to very little vitamin K passing through the placenta. Breastfeeding alone will not prevent a decrease in the infant's already low vitamin K stores and may progress to vitamin K deficiency within 48-72 hours. If a nursing mother takes certain medications, such as anticonvulsants, anti-tuberculosis drugs, or warfarin, it can cause typical and early neonatal hemorrhagic disease. In contrast, breastfeeding is considered to be a cause of typical and late infant hemorrhagic disease. Using Phytomenadion for infants to prevent disease by preventing factors II, VII, IX and X continue to decrease. In summary, natural vitamin K content in breast milk is too low to protect infants from vitamin K deficiency, leading to neonatal haemorrhagic disease. Phytomenadion should be given to all newborns 0.5 - 1.0mg to prevent disease, possibly requiring larger doses or repeated injections in the case of mothers taking anticonvulsants or oral anticoagulants. Ability to drive and use machines: Using Tonadione medicine may appear undesirable effects such as hypotension, dizziness, dizziness, which may affect the ability to drive and use machines. Phytomenadion may be transiently resistant to anticoagulants that inhibit prothrombin, especially when high doses of Phytomenadion are used. In case of using relatively large doses of Phytomenadion, it is possible to use a slightly higher dose of prothrombin anticoagulants than normal doses, or to use substances acting by other mechanisms such as heparin sodium.

4. Unwanted effects when using the drug Tonadione


Using Tonadione intravenously, especially intravenously, can cause hot flushes, hypotension, weak pulse, sweating, dizziness, dizziness, cyanosis, taste changes, anaphylactoid reactions , allergy. Tonadione in doses greater than 25 mg may cause hyperbilirubinemia in neonates or premature infants.
Tonadione given intravenously can cause severe anaphylactoid reactions, leading to shock, cardiac arrest, respiratory arrest and death.
Phytomenadion may cause skin and respiratory tract irritation. Tonadione solution has blistering properties. Local skin reactions with the use of Tonadione are rare.

5. Drug interactions


Do not mix Tonadione with other infusion solutions. Dicumarol and derivatives with an antagonistic effect on vitamin K: when used concurrently with Tonadione may reduce or lose the effect of these drugs. When hypoprothrombinemia was caused by treatment with gentamicin and clindamycin, the patient did not respond to intravenous vitamin K. Concomitant use of Tonadione with anticonvulsants may reduce the effect of vitamin K1.

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