To: Illinois Pharmacies and Pharmacists
From: Illinois Department of Public Health
Date: March 28, 2018
Re: Ensure Sufficient Vitamin K1 (Phytonadione) Supply
Several cases of Vitamin-K-dependent coagulopathy (similar to warfarin) have been reported in Illinois associated with use of synthetic cannabinoids. Although these patients have primarily been located in the northeastern part of Illinois, additional cases from other parts of the state have been reported.
As these patients are stabilized and released from the hospital, they will be prescribed large doses (≥50mg/day) of long-term Vitamin K1 (phytonadione) to manage their symptoms. They may need these large doses for several weeks to months. Although unusual to see such high doses prescribed, due to the long-acting nature of this poisoning, these high doses are required.
Please check your stock of oral phytonadione to ensure that if any of these patients present to your pharmacy, you are able to fill their prescriptions. Be aware that you may receive more than one patient. Please work with your supplier(s) to ensure that you have an adequate supply of this drug.
Due to the high costs associated with these prescriptions, we ask that you work with patients to try to identify the most cost-effective formulations. Counsel these patients that compliance with the prescribed phytonadione therapy and laboratory monitoring is necessary to prevent recurrence of bleeding complications. Additionally, patients should be advised that OTC dietary supplements containing phytonadione only contain on the order of 100mcg (0.1mg) and are not an effective treatment for this coagulopathy.
If you see these patients and have any questions about appropriate dosing, please contact the Illinois Poison Center at 1-800-222-1222.