Can Micro K (Vitamin K) capsules be opened for patients with difficulty swallowing, particularly those with a history of bleeding or thrombosis and anticoagulant therapy?

Micro-K Capsules Should NOT Be Opened

Micro-K (potassium chloride extended-release) capsules are specifically designed as controlled-release formulations and should never be opened, crushed, or chewed, as this destroys the extended-release mechanism and can cause serious gastrointestinal injury, hyperkalemia, and potentially fatal cardiac arrhythmias.

Critical Safety Concerns

The evidence provided addresses vitamin K (phytonadione) for warfarin reversal, which is an entirely different medication from Micro-K (potassium chloride). These are fundamentally different drugs with different indications, mechanisms, and safety profiles.

Why Micro-K Capsules Cannot Be Opened

• Extended-release formulations of potassium chloride are designed to release the medication slowly throughout the GI tract to prevent localized high concentrations that cause ulceration, bleeding, and perforation
• Opening the capsule releases the entire dose immediately, creating dangerous potassium concentrations that can cause:
  • Severe esophageal and gastric ulceration
  • GI bleeding and perforation
  • Rapid absorption leading to hyperkalemia
  • Cardiac arrhythmias and potential cardiac arrest

Alternative Options for Patients with Swallowing Difficulties

Liquid Formulations

• Potassium chloride oral solution (10-20 mEq/15 mL) is available for patients who cannot swallow capsules
• Must be diluted in water or juice to improve palatability and reduce GI irritation

Administration Strategies

• Consider smaller capsule sizes if available
• Evaluate for alternative routes (IV potassium) if oral intake is not feasible
• Address the underlying swallowing difficulty with speech therapy evaluation

Common Pitfalls to Avoid

• Never crush, chew, or open any extended-release potassium formulation
• Do not confuse vitamin K (phytonadione) with potassium chloride (Micro-K) - they are completely different medications
• Avoid rapid potassium replacement which increases risk of hyperkalemia and cardiac complications
• Monitor serum potassium levels closely when changing formulations or routes of administration

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Note: The evidence provided in this query pertains to vitamin K (phytonadione) for warfarin reversal 1, 2, 3, 4, not potassium chloride (Micro-K). If you intended to ask about vitamin K capsules, injectable vitamin K can be administered orally as an alternative to tablets 5, but this is a different clinical question entirely.