NDC 76329-1240 Phytonadione

Phytonadione

NDC Product Code 76329-1240

NDC CODE: 76329-1240

Proprietary Name: Phytonadione What is the Proprietary Name?
The proprietary name also known as the trade name is the name of the product chosen by the medication labeler for marketing purposes.

Non-Proprietary Name: Phytonadione What is the Non-Proprietary Name?
The non-proprietary name is sometimes called the generic name. The generic name usually includes the active ingredient(s) of the product.

Drug Use Information

Drug Use Information
The drug use information is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate. This information is not individual medical advice and does not substitute for the advice of a health care professional. Always ask a health care professional for complete information about this product and your specific health needs.

  • Vitamin K is used to treat and prevent low levels of certain substances (blood clotting factors) that your body naturally produces. These substances help your blood to thicken and stop bleeding normally (such as after an accidental cut or injury). Low levels of blood clotting factors increase the risk for unusual bleeding. Low levels may be caused by certain medications (such as warfarin) or medical conditions (such as obstructive jaundice). Vitamin K helps to treat and prevent unusual bleeding by increasing the body's production of blood clotting factors.

NDC Code Structure

  • 76329 - International Medication Systems, Limited

NDC 76329-1240-1

Package Description: 1 SYRINGE in 1 CARTON > .5 mL in 1 SYRINGE

NDC Product Information

Phytonadione with NDC 76329-1240 is a a human prescription drug product labeled by International Medication Systems, Limited. The generic name of Phytonadione is phytonadione. The product's dosage form is injection, emulsion and is administered via intramuscular; intravenous; subcutaneous form.

Labeler Name: International Medication Systems, Limited

Dosage Form: Injection, Emulsion - An emulsion consisting of a sterile, pyrogen-free preparation intended to be administered parenterally.

Product Type: Human Prescription Drug What kind of product is this?
Indicates the type of product, such as Human Prescription Drug or Human Over the Counter Drug. This data element matches the “Document Type” field of the Structured Product Listing.

Phytonadione Active Ingredient(s)

What is the Active Ingredient(s) List?
This is the active ingredient list. Each ingredient name is the preferred term of the UNII code submitted.

  • PHYTONADIONE 1 mg/.5mL

Administration Route(s)

What are the Administration Route(s)?
The translation of the route code submitted by the firm, indicating route of administration.

  • Intramuscular - Administration within a muscle.
  • Intravenous - Administration within or into a vein or veins.
  • Subcutaneous - Administration beneath the skin; hypodermic. Synonymous with the term SUBDERMAL.

Pharmacological Class(es)

What is a Pharmacological Class?
These are the reported pharmacological class categories corresponding to the SubstanceNames listed above.

  • Increased Prothrombin Activity - [PE] (Physiologic Effect)
  • Reversed Anticoagulation Activity - [PE] (Physiologic Effect)
  • Vitamin K - [CS]
  • Vitamin K - [EPC] (Established Pharmacologic Class)
  • Warfarin Reversal Agent - [EPC] (Established Pharmacologic Class)

Product Labeler Information

What is the Labeler Name?
Name of Company corresponding to the labeler code segment of the Product NDC.

Labeler Name: International Medication Systems, Limited
Labeler Code: 76329
FDA Application Number: ANDA083722 What is the FDA Application Number?
This corresponds to the NDA, ANDA, or BLA number reported by the labeler for products which have the corresponding Marketing Category designated. If the designated Marketing Category is OTC Monograph Final or OTC Monograph Not Final, then the Application number will be the CFR citation corresponding to the appropriate Monograph (e.g. “part 341”). For unapproved drugs, this field will be null.

Marketing Category: ANDA - A product marketed under an approved Abbreviated New Drug Application. What is the Marketing Category?
Product types are broken down into several potential Marketing Categories, such as NDA/ANDA/BLA, OTC Monograph, or Unapproved Drug. One and only one Marketing Category may be chosen for a product, not all marketing categories are available to all product types. Currently, only final marketed product categories are included. The complete list of codes and translations can be found at www.fda.gov/edrls under Structured Product Labeling Resources.

Start Marketing Date: 04-18-2003 What is the Start Marketing Date?
This is the date that the labeler indicates was the start of its marketing of the drug product.

Listing Expiration Date: 12-31-2021 What is the Listing Expiration Date?
This is the date when the listing record will expire if not updated or certified by the product labeler.

Exclude Flag: N - NO What is the NDC Exclude Flag?
This field indicates whether the product has been removed/excluded from the NDC Directory for failure to respond to FDA"s requests for correction to deficient or non-compliant submissions ("Y"), or because the listing certification is expired ("E"), or because the listing data was inactivated by FDA ("I"). Values = "Y", "N", "E", or "I".

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Information for Patients

Vitamin K

Vitamin K is


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Phytonadione Product Labeling Information

The product labeling information includes all published material associated to a drug. Product labeling documents include information like generic names, active ingredients, ingredient strength dosage, routes of administration, appearance, usage, warnings, inactive ingredients, etc.

Product Labeling Index

Other

Aqueous Colloidal Solution of Vitamin K1Rx Only

INTERNATIONAL MEDICATION SYSTEMS, LIMITEDSO. EL MONTE, CA 91733, U.S.A.An Amphastar Pharmaceuticals Company                            Rev. 7-13© INTERNATIONAL MEDICATION SYSTEMS, LIMITED 2013

Warning - Intravenous Use

Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of Phytonadione. Typically these severe reactions have resembled hypersensitivity or anaphylaxis, including shock and cardiac and/or respiratory arrest. Some patients have exhibited these severe reactions on receiving Phytonadione for the first time. The majority of these reported events occurred following intravenous administration, even when precautions have been taken to dilute the Phytonadione and to avoid rapid infusion. Therefore, the INTRAVENOUS route should be restricted to those situations where another route is not feasible and the increased risk involved is considered justified.

Description

Phytonadione is a vitamin, which is a clear, yellow to amber, viscous, odorless or nearly odorless liquid. It is insoluble in water, soluble in chloroform and slightly soluble in ethanol. It has a molecular weight of 450.70.Phytonadione is 2-methyl-3-phytyl-1, 4-naphthoquinone. Its empirical formula is C31H4602 and its structural formula is:Phytonadione Injectable Emulsion, USP, is a yellow, sterile, aqueous colloidal solution of vitamin K1, with a pH of 3.5 to 7.0. It is available for injection by the intravenous, intramuscular, and subcutaneous routes.Each 0.5 mL contains 1 mg phytonadione (Vitamin K1), 10 mg polysorbate 80, 10.4 mg propylene glycol, 0.17 mg sodium acetate anhydrous, and 0.00002 mL glacial acetic acid. Additional glacial acetic acid or sodium acetate anhydrous may have been added to adjust pH to meet USP limits of 3.5 to 7.0. The air above the liquid in the individual containers has been displaced by flushing with nitrogen during the filling operation.

Clinical Pharmacology

Phytonadione aqueous colloidal solution of vitamin K1 for parenteral injection, possesses the same type and degree of activity as does naturally-occurring vitamin K, which is necessary for the production via the liver of active prothrombin (factor II), proconvertin (factor VII), plasma thromboplastin component (factor IX), and Stuart factor (factor X). The prothrombin test is sensitive to the levels of three of these four factors—II, Vll, and X. Vitamin K is an essential cofactor for a microsomal enzyme that catalyzes the post-translational carboxylation of multiple, specific, peptide-bound glutamic acid residues in inactive hepatic precursors of factors II, VII, IX, and X. The resulting gamma-carboxyglutamic acid residues convert the precursors into active coagulation factors that are subsequently secreted by liver cells into the blood.Phytonadione is readily absorbed following intramuscular administration. After absorption, phytonadione is initially concentrated in the liver, but the concentration declines rapidly. Very little vitamin K accumulates in tissues. Little is known about the metabolic fate of vitamin K. Almost no free unmetabolized vitamin K appears in bile or urine.In normal animals and humans, phytonadione is virtually devoid of pharmacodynamic activity. However, in animals and humans deficient in vitamin K, the pharmacological action of vitamin K is related to its normal physiological function, that is, to promote the hepatic biosynthesis of vitamin K dependent clotting factors.The action of the aqueous colloidal solution, when administered intravenously, is generally detectable within an hour or two and hemorrhage is usually controlled within 3 to 6 hours. A normal prothrombin level may often be obtained in 12 to 14 hours.In the prophylaxis and treatment of hemorrhagic disease of the newborn, phytonadione has demonstrated a greater margin of safety than that of the water-soluble vitamin K analogues.

Indications And Usage

Phytonadione is indicated in the following coagulation disorders which are due to faulty formation of factors II, VII, IX and X when caused by vitamin K deficiency or interference with vitamin K activity.Phytonadione Injectable Emulsion, USP is indicated in:— anticoagulant-induced prothrombin deficiency caused by coumarin or indanedione derivatives;— prophylaxis and therapy of hemorrhagic disease of the newborn;— hypoprothrombinemia due to antibacterial therapy;— hypoprothrombinemia secondary to factors limiting absorption or synthesis of vitamin K, e.g., obstructive jaundice, biliary fistula, sprue, ulcerative colitis, celiac disease, intestinal resection, cystic fibrosis of the pancreas, and regional enteritis;— other drug-induced hypoprothrombinemia where it is definitely shown that the result is due to interference with vitamin K metabolism, e.g., salicylates.

Contraindication

Hypersensitivity to any component of this medication.

Warnings

An immediate coagulant effect should not be expected after administration of phytonadione. It takes a minimum of 1 to 2 hours for measurable improvement in the prothrombin time. Whole blood or component therapy may also be necessary if bleeding is severe.Phytonadione will not counteract the anticoagulant action of heparin.When vitamin K1 is used to correct excessive anticoagulant-induced hypoprothrombinemia, anticoagulant therapy still being indicated, the patient is again faced with the clotting hazards existing prior to starting the anticoagulant therapy. Phytonadione is not a clotting agent, but overzealous therapy with vitamin K1 may restore conditionswhich originally permitted thromboembolic phenomena. Dosage should be kept as low as possible, and prothrombin time should be checked regularly as clinical conditions indicate.Repeated large doses of vitamin K are not warranted in liver disease if the response to initial use of the vitamin is unsatisfactory. Failure to respond to vitamin K may indicate that the condition being treated is inherently unresponsive to vitamin K.

Drug Interactions

Temporary resistance to prothrombin-depressing anticoagulants may result, especially when larger doses of phytonadione are used. If relatively large doses have been employed, it may be necessary when reinstituting anticoagulant therapy to use somewhat larger doses of the prothrombin-depressing anticoagulant, or to use one which acts on a different principle, such as heparin sodium.

Laboratory Tests

Prothrombin time should be checked regularly as clinical conditions indicate.

Carcinogenesis, Mutagenesis, Impairment Of Fertility

Studies of carcinogenicity, mutagenesis or impairment of fertility have not been conducted with phytonadione.

Pregnancy

Pregnancy Category C: Animal reproduction studies have not been conducted with phytonadione. It is also not known whether phytonadione can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Phytonadione should be given to a pregnant woman only if clearly needed.

Nursing Mothers

It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when phytonadione is administered to a nursing woman.

Pediatric Use

Hemolysis, jaundice, and hyperbilirubinemia in newborns, particularly in premature infants, may be related to the dose of phytonadione. Therefore, the recommended dose should not be exceeded (see ADVERSE REACTIONS and DOSAGE AND ADMINISTRATION).

Adverse Reactions

Severe hypersensitivity reactions, including anaphylactoid reactions and deaths have been reported following parenteral administration. The majority of these reported events occurred following intravenous administration (see Box Warning.)The possibility of allergic sensitivity, including an anaphylactoid reaction, should be kept in mind following parenteral administration.Transient “flushing sensations” and “peculiar” sensations of taste have been observed, as well as rare instances of dizziness, rapid and weak pulse, profuse sweating, brief hypotension, dyspnea, and cyanosis.Pain, swelling, and tenderness at the injection site may occur.Infrequently, usually after repeated injection, erythematous, indurated, pruritic plaques have occurred; rarely, these have progressed to scleroderma-like lesions that have persisted for long periods. In other cases, these lesions have resembled erythema perstans.Hyperbilirubinemia has been observed in the newborn following administration of phytonadione. This has occurred rarely and primarily with doses above those recommended. (See PRECAUTIONS, Pediatric Use.)

Overdosage

The intravenous LD50 of Phytonadione Injectable Emulsion, USP in the mouse is 41.5 and 52 mL/kg for the 0.2% and 1.0% concentrations, respectively.

Dosage And Administration

Whenever possible, phytonadione should be given by the subcutaneous route (see Box WARNING). When intravenous or intramuscular administration is considered unavoidable, the drug should be injected very slowly, not exceeding 1 mg per minute.Protect from light at all times.Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration,whenever solution and container permit.Directions for DilutionPhytonadione may be diluted with 0.9% Sodium Chloride Injection, 5% Dextrose Injection, or 5% Dextrose and Sodium Chloride Injection. Benzyl alcohol as a preservative has been associated with toxicity in newborns. Therefore, all of the above diluents should be preservative-free. (See WARNINGS) Other diluents should not be used. When dilutions are indicated, administration should be started immediately after mixture with the diluent, and unused portions of the dilution should be discarded, as well as unused contents of the vial.Prophylaxis of Hemorrhagic Disease of the NewbornThe American Academy of Pediatrics recommends that vitamin K1 be given to the newborn. A single intramuscular dose of phytonadione 0.5 to 1 mg within one hour of birth is recommended.Treatment of Hemorrhagic Disease of the NewbornEmpiric administration of vitamin K1 should not replace proper laboratory evaluation of the coagulation mechanism. A prompt response (shortening of the prothrombin time in 2 to 4 hours) following administration of vitamin K1 is usually diagnostic of hemorrhagic disease of the newborn, and failure to respond indicates another diagnosis or coagulation disorder.Phytonadione 1 mg should be given either subcutaneously or intramuscularly. Higher doses may be necessary if the mother has been receiving oral anticoagulants.Whole blood or component therapy may be indicated if bleeding is excessive. This therapy, however, does not correct the underlying disorder and phytonadione should be given concurrently.Anticoagulant-lnduced Prothrombin Deficiency in AdultsTo correct excessively prolonged prothrombin time caused by oral anticoagulant therapy 2.5 to 10 mg or up to 25 mg initially is recommended. In rare instances 50 mg may be required. Frequency and amount of subsequent doses should be determined by prothrombin time response or clinical condition (see WARNINGS). If in 6 to 8 hours after parenteral administration the prothrombin time has not been shortened satisfactorily, the dose shouldberepeated.                                                              Phytonadione                                                Summary of Dosage Guidelines                                                    (See insert text for details)Newborns DosageHemorrhagic Disease of the NewbornProphylaxisTreatment 0.5 - 1 mg IM within 1 hour of birth 1 mg SC or IM(Higher doses may be necessary ifthe mother has been receivingoral anti-coagulants) Adults Initial DosageAnticoagulant - InducedProthrombin Deficiency(caused by coumarin orindanedione derivatives)2.5 mg - 10 mg or up to 25 mg(rarely 50 mg)Hypoprothrombinemia due toother causes(Antibiotics; Salicylates or other drugs;Factors limiting absorption or synthesis)2.5 mg - 25 mg or more (rarely up to 50 mg)In the event of shock or excessive blood loss, the use of whole blood or component therapy is indicated.Hypoprothrombinemia Due to Other Causes in AdultsA dosage of 2.5 to 25 mg or more (rarely up to 50 mg) is recommended, the amount and route of administration depending upon the severity of the condition and response obtained.If possible, discontinuation or reduction of the dosage of drugs interfering with coagulation mechanisms (such as salicylates, antibiotics) is suggested as an alternative to administering concurrent phytonadione. The severity of the coagulation disorder should determine whether the immediate administration of phytonadione is required in addition to discontinuation or reduction of interfering drugs.

How Supplied

In unit use packages containing one single dose vial and a SAF-T-Jet® vial injector, 27 G. x 1/2” needle.Phytonadione Injection USP, 1 mg in 0.5 mLStock No. 1240    NDC 76329-1240-110 individual cartons shrink wrapped as a group of 10 cartons.Syringe Assembly Directions:See User GuideUSE ASEPTIC TECHNIQUEDo not remove from carton or assemble until ready to use.*CAUTION: IMPROPER ENGAGING MAY CAUSE GLASS BREAKAGE AND SUBSEQUENT INJURY.Store at controlled room temperature 15° to 30°C (59° to 86°F) [see USP].Protect from light.

Principle Display Panel: Syringe Label

IMS, LIMITEDSo. El Monte, CA 91733, U.S.A.7612400C 7-130.5 mL    1 mg     1 mg / 0.5 mLPHYTONADIONE INJECTABLE EMULSION, USPNEONATAL CONCENTRATIONFOR I.M. OR S.C. USESINGLE DOSE / SEE INSERTPROTECT FROM LIGHTRx OnlyApprox. mg   mL   1   0.5     0.5   0.25

Principle Display Panel: Carton

SAF-T-JET®NDC 76329-1240-1STOCK NO. 1240Rx OnlySAF-T-JET®27 G. X 1/2" NEEDLEPHYTONADIONE INJECTABLE EMULSION USPNEONATAL CONCENTRATION1 mg per 0.5 mLSingle use, do not reuse or resterilize.FOR INTRAMUSCULAR OR SUBCUTANEOUS USE

Principle Display Panel: User Guide

IMS Saf-T-Jet® Safety NeedleUSER GUIDE NOTE: USE ASEPTIC TECHNIQUEDo not assemble until ready to use1 Ensure shield is in the UP position (see inset), then remove protective caps from vial and injector.2 Align vial such that the injector needle is centered on the stopper. Thread vial into injection 3 half turns to ensure the needle penetrates stopper. Do not push the injector needle into stopper.3 a) Flip shield down.   b) Remove needle cover PULLING STRAIGHT UP (DO NOT TWIST). Expel air.4 Administer injection following the established aseptic technique.5 Position shield in preparation for device activation: Using a one-handed technique, push the tab forward with your finger or thumb so that the shield is less than 90 degrees from the needle. NOTE: Keep your finger or thumb behind the tab at all times.6 Activate shield: Position the shield approximately 45 degrees to flat surface. Press down with a GENTLE, QUICK MOTION until a distinct AUDIBLE CLICK is heard. Note: Audible click may not be heard on small needle sizes: visual confirmation is required. 7VISUALLY CONFIRM that needle is fully engaged under lock.8 Following activation of the needle shield, immediately discard the unit into an approved sharps container.For additional questions or to request a traning video, contact Customer Service at (800) 423-4136.7012400E 9-09

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