Drugs List

Therapeutic Indications

Uses

Prevention of haemorrhage associated with low prothrombin level
Treatment of haemorrhage associated with low prothrombin level

Contraindications

Infants
Neonates
Galactosaemia
Peri-natal period
Third trimester of pregnancy

Precautions and Warnings

Vitamin E deficiency
G6PD deficiency
Glucose-galactose malabsorption syndrome
Lactose intolerance

Contains lactose
Monitor patients receiving concurrent anticoagulants
Possible development of haemolytic anaemia in neonates - premature infants
Possible development of hyperbilirubinaemia in neonates-premature infants
Possible development of kernicterus in neonates - premature infants

Pregnancy and Lactation

Pregnancy

Menadiol is contraindicated during late pregnancy.

There is evidence of hazard if menadiol is used in human pregnancy. It is known to be associated with a small risk of haemolytic anaemia, hyperbilirubinaemia and kernicterus in the infant if administered to the mother in late pregnancy or during labour.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Menadiol can be used during breastfeeding.

The UK Drugs in Lactation Advisory Service consider that menadiol is safe to use during breastfeeding. Hale also states that vitamin K transfer to milk is low (Hale 2014).

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Haemolysis

Presentation

Tablet containing menadiol.

Drugs List

Therapeutic Indications

Uses

Prevention of haemorrhage associated with low prothrombin level
Treatment of haemorrhage associated with low prothrombin level

Dosage

Adults

Children

Contraindications

Infants
Neonates
Galactosaemia
Peri-natal period
Third trimester of pregnancy

Precautions and Warnings

Vitamin E deficiency
G6PD deficiency
Glucose-galactose malabsorption syndrome
Lactose intolerance

Contains lactose
Monitor patients receiving concurrent anticoagulants
Possible development of haemolytic anaemia in neonates - premature infants
Possible development of hyperbilirubinaemia in neonates-premature infants
Possible development of kernicterus in neonates - premature infants

Pregnancy and Lactation

Pregnancy

Menadiol is contraindicated during late pregnancy.

There is evidence of hazard if menadiol is used in human pregnancy. It is known to be associated with a small risk of haemolytic anaemia, hyperbilirubinaemia and kernicterus in the infant if administered to the mother in late pregnancy or during labour.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Menadiol can be used during breastfeeding.

The UK Drugs in Lactation Advisory Service consider that menadiol is safe to use during breastfeeding. Hale also states that vitamin K transfer to milk is low (Hale 2014).

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Haemolysis

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: June 2016

Reference Sources

Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

Summary of Product Characteristics: Menadiol Diphosphate tablets 10mg. Alliance Pharmaceuticals. Revised January 2015

UK Drugs in Lactation Advisory Service.
Available at: https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Last accessed: 24 June 2016

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 04 September 2017