II. Indications
- Severe Iron Deficiency Anemia and iron malabsorption
- Chronic bleeding not corrected by other means
- Oral iron not tolerated
- Severe Anemia and refusal of Blood Transfusion
III. Preparations
- Sodium Ferric Gluconate (Ferrlecit)
- Dosing: 125 mg (10 ml) of 62.5 mg/5 ml solution diluted in 100 ml saline
- May give weekly IV for 8 weeks (total: 1 gram)
- Much safer than Iron Dextran
- Test dose recommended with 2 ml diluted in 50 ml saline infused over 1 hour prior to first infusion
-
Iron sucrose (Venofer)
- Much safer than Iron Dextran (no test dose needed)
- Dosing: 100 mg (20 ml) IV of 20 mg/ml solution for 5 doses over 2 week period (1-3 times per week)
- Ferumoxytol (Feraheme)
- Single infusion given over 5 minutes supplies 510 mg elemental iron per 17 ml solution
- May repeat in 3-8 days for second injection
- U.S. FDA black box warning for serious Allergic Reactions (monitor for Hypersensitivity, Hypotension)
- Ferric Carboxymaltose (Injectafer)
- Available as 750 mg/15 ml solution
- Monitor for Hypersensitivity
- Variable Blood Pressure effects with Hypertension in 3.8% and Hypotension in 1% of patients
- Dosing
- Weight >50 kg (110 lb): Give 750 mg (15 ml) in 2 doses at 7 days apart
- Weight <50 kg (110 lb): Give 15 mg/kg in 2 doses at 7 days apart
- Iron Dextran (Imferon, Dexferrum, Infed)
- High rate of serious reaction (requires test dose of 0.5 ml one hour before infusion)
- Replaced by newer agents (e.g. Ferrlecit, Feraheme, Venofer)
- Intramuscular or Intravenous
- Available as 50 mg/ml
- Dose based on estimated iron deficits
IV. Precautions
- Intravenous Iron must be started very slowly
- Avoid in patients with acute or chronic infections
V. Efficacy
- Hemoglobin increased 2 g/dl (NNT 5)
- Red Blood Cell Transfusion avoided (NNT 36)
- Oral iron is as effective as Parenteral Iron in preventing Blood Transfusion and mortality
- Oral iron is preferred in those without significant malabsorption or other barriers to oral ingestion
- Mounsey (2022) Am Fam Physician 106(2): 191-2 [PubMed]
VI. Adverse Effects
- Skin staining at site of Intramuscular Injection
- Consider Z-tract injection technique
- Severe pain at injection site
- Infection Risk (NNH: 62)
- Delayed reaction (24-48 hours after administered)
- Myalgias and Arthralgias
- Headache
-
Anaphylaxis
- Occurs in 0.61% of patients given Iron Dextran
- Occurs in 0.04% of patients given ferric gluconate
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Related Studies
| Definition (NCI) | A colloidal solution containing ferric oxyhydroxide complexed with polymerized dextran, used as a form of parenteral iron-replacement therapy. Upon administration and absorption, the iron dextran complex is removed from plasma by the reticuloendothelial system which cleaves it into the components iron and dextran; ferric iron subsequently binds to transferrin or is stored as hemosiderin or ferritin. Transferrin-bound iron is transported in the plasma to the liver, spleen and bone marrow, where is it is incorporated into hemoglobin (Hgb) and to muscle where it is incorporated into myoglobin (Mb). Use of this agent circumvents the gastrointestinal adverse effects commonly encountered with the use of orally administered iron salt preparations. Because of cross-reactivity with antibodies targeted against polysaccharides similar to dextran, anaphylactic reactions may occur with this type of iron formulation. |
| Definition (MSH) | A complex of ferric oxyhydroxide with dextrans of 5000 to 7000 daltons in a viscous solution containing 50 mg/ml of iron. It is supplied as a parenteral preparation and is used as a hematinic. (Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed, p1292) |
| Concepts | Carbohydrate (T118) , Pharmacologic Substance (T121) |
| MSH | D007505 |
| SnomedCT | 100874006, 100875007, 21767006, 387118003 |
| English | Dextran-Iron Complex, Ferridextran, Dextran Iron Complex, Iron Dextran Complex, IRON DEXTRAN -Retired-, Iron-Dextran Complex, iron dextran, IRON DEXTRAN, Iron-Dextran Complex [Chemical/Ingredient], Iron Dextran, dextran iron, iron dextran complex, IRON DEXTRAN (substance), IRON DEXTRAN COMPLEX (product), Iron dextran, Iron dextran (product), Iron dextran (substance), Iron dextran complex, IRON DEXTRAN COMPLEX (substance), IRON DEXTRAN COMPLEX |
| Swedish | Järn-dextrankomplex |
| Czech | železo-dextranový komplex |
| Finnish | Rauta-dekstraanikompleksi |
| Russian | ZHELEZO-DEKSTRANOVYI KOMPLEKS, DEKSTRAN-ZHELEZO KOMPLEKS, ДЕКСТРАН-ЖЕЛЕЗО КОМПЛЕКС, ЖЕЛЕЗО-ДЕКСТРАНОВЫЙ КОМПЛЕКС |
| Japanese | 鉄-デキストラン錯体, デキストラン-鉄錯体, デキストラン鉄錯塩 |
| Italian | Ferridestrano, Complesso ferro-destrano |
| Spanish | hierro dextrano, hierro dextrano (producto), hierro dextrán, hierro dextran (sustancia), hierro dextran (producto), hierro dextran, hierro dextrán (sustancia), IRON DEXTRAN COMPLEX (producto), IRON DEXTRAN COMPLEX, IRON DEXTRAN (sustancia), IRON DEXTRAN - RETIRADO -, IRON DEXTRAN - RETIRADO - (concepto no activo), IRON DEXTRAN COMPLEX (sustancia), hierro dextrano (sustancia), Complejo Dextran-Hierro, Complejo Hierro-Dextran |
| Polish | Kompleks żelazowo-dekstranowy |
| French | Dextriferron |
| German | Dextran-Eisen-Komplex, Eisen-Dextran-Komplex |
| Portuguese | Complexo Dextran-Ferro, Complexo Ferro-Dextran |
Ontology: ferumoxytol (C0060274)
| Definition (MSH) | Iron (II,III) oxide (Fe3O4). It is a black ore of IRON that forms opaque crystals and exerts strong magnetism. |
| Definition (NCI) | A superparamagnetic iron oxide nanoparticle coated with a low molecular weight semi-synthetic carbohydrate, polyglucose sorbitol carboxymethyl ether, with potential anti-anemic and imaging properties. After intravenous administration, ferumoxytol replaces iron stores with fewer side effects compared to the use of oral iron. In addition, this agent generates T1 relaxation, producing a magnetic field and enhancing T2 relaxation, thereby darkening contrast media-containing structures in magnetic resonance imaging (MRI). Due to small particle size, ferumoxytol remains in the intravasculature for a prolonged period and so may be used as a blood pool agent. |
| Definition (NCI_NCI-GLOSS) | A nanoparticle form of iron made in the laboratory that is being studied for use in iron replacement therapy, and as a contrast agent for magnetic resonance imaging. Contrast agents are substances that are injected into the body and taken up by certain tissues, making the tissues easier to see in imaging scans. |
| Definition (PDQ) | A superparamagnetic iron oxide nanoparticle coated with a low molecular weight semi-synthetic carbohydrate, polyglucose sorbitol carboxymethyl ether, with potential anti-anemic and imaging properties. After intravenous administration, ferumoxytol replaces iron stores with fewer side effects compared to the use of oral iron. In addition, this agent generates T1 relaxation, producing a magnetic field and enhancing T2 relaxation, thereby darkening contrast media-containing structures in magnetic resonance imaging (MRI). Due to small particle size, ferumoxytol remains in the intravasculature for a prolonged period and so may be used as a blood pool agent. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=377345&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=377345&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C38138" NCI Thesaurus) |
| Concepts | Indicator, Reagent, or Diagnostic Aid (T130) , Inorganic Chemical (T197) |
| MSH | D052203 |
| SnomedCT | 442951001, 442952008, 51922007 |
| Russian | ЖЕЛЕЗА (II, III) ОКСИД, ЖЕЛЕЗА (II), (III) ОКСИД, ЖЕЛЕЗА (II)(III) ОКСИД, ZHELEZA (II, III) OKSID, ZHELEZA (II)(III) OKSID, ZHELEZA ZAKIS'-OKIS', ZHELEZA (II), (III) OKSID, МАГНЕТИТ, MAGNETIT, FERUMOKSITOL, ФЕРУМОКСИТОЛ, FE3O4, ЖЕЛЕЗА ЗАКИСЬ-ОКИСЬ |
| Italian | Ossido ferroso ferrico, Ossido ferroso-ferrico |
| Swedish | Magnetit |
| Czech | oxid železnato-železitý, oxid železnatoželezitý |
| Finnish | Rautaoksidi |
| Japanese | 磁鉄鉱, マグネタイト, 四三酸化鉄, 黒色酸化鉄, 磁性酸化鉄, 酸化鉄(III)鉄(II), 酸化第一鉄第二鉄 |
| English | Triiron Tetraoxide, Black Iron Oxide, Magnetic Black, Iron Black, FERUMOXYTOL NON-STOICHIOMETRIC MAGNETITE, FERUMOXYTOL, Ferumoxytol (substance), Ferumoxytol (product), ferumoxytol, Ferrosoferric Oxide [Chemical/Ingredient], Ferumoxytol Non-Stoichiometric Magnetite, FERROSOFERRIC OXIDE, ferrosoferric oxide, Ferrosoferric oxide, C.I. 77499, Iron (II, III) Oxide, Ferumoxytol, Black iron oxide, Ferriferrous Oxide, Ferrosoferric Oxide, Oxide, Ferriferrous, Oxide, Ferrosoferric |
| Spanish | ferumoxytol (producto), ferumoxytol (sustancia), ferumoxytol, Óxido Ferrosoférrico, Ferumoxitol, Not Translated[Ferrosoferric Oxide], óxido de hierro negro |
| French | Oxyde de fer noir, Férumoxytol, Oxyde ferrosoferrique |
| Polish | Magnetyd, Ferumoksytol, Farhem |
| German | Ferumoxytol, Ferroferrioxid |
| Norwegian | Magnetitt |
| Portuguese | Ferumoxitol, Óxido Ferroso-Férrico, Not Translated[Ferrosoferric Oxide] |
Ontology: Ferrlecit (C0117571)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | C035552 |
| English | Ferrlecit, ferrlecit |
Ontology: Parenteral iron (C0444624)
| Concepts | Pharmacologic Substance (T121) |
| SnomedCT | 255668001 |
| English | Parenteral iron, iron parenteral, parenteral iron, Parenteral form iron (product), Parenteral form iron, Parenteral iron (product), Parenteral iron (substance) |
| Spanish | hierro parenteral, hierro parenteral (producto), hierro, forma farmacéutica parenteral (producto), hierro, forma farmacéutica parenteral |
Ontology: Venofer (C0529374)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | C101222 |
| English | Venofer, venofer |
Ontology: Imferon (C0701986)
| Concepts | Organic Chemical (T109) , Pharmacologic Substance (T121) |
| MSH | D007505 |
| English | imferon, Imferon, Sanofi Brand of Iron-Dextran Complex |
Ontology: Sodium ferric gluconate complex (C0875947)
| Definition (NCI_NCI-GLOSS) | A form of the mineral iron that is used to treat anemia caused by low amounts of iron in the blood. Anemia is a condition in which the number of red blood cells is below normal. Ferrlecit is a type of hematinic and a dietary supplement. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| SnomedCT | 116130008 |
| English | FERRIC NA GLUCONATE, sodium ferric gluconate complex, na ferric gluconate, ferric sodium gluconate, SODIUM FERRIC GLUCONATE COMPLEX, sod ferric gluc complex, sodium ferric gluconate, Sodium ferric gluconate complex, Sodium ferric gluconate complex (substance), FERRIC NA GLUCONATE COMPLEX, Sodium Ferric Gluconate Complex |
| Spanish | complejo de gluconato férrico de sodio (sustancia), complejo de gluconato férrico de sodio |
Ontology: iron sucrose injection (C1831745)
| Definition (NCI) | A sterile aqueous complex of polynuclear iron (III)-hydroxide in sucrose for intravenous use. Following intravenous administration, iron sucrose is dissociated by the reticuloendothelial system into iron and sucrose; the sucrose component is eliminated mainly by urinary excretion. Iron sucrose can be administered with or without erythropoietin to raise hemoglobin levels and may be used in cases of oral iron therapy intolerance or ineffectiveness. Hypersensitivity reactions are less common with iron sucrose compared to other parenteral iron products, such as iron dextran. |
| Definition (PDQ) | A sterile aqueous complex of polynuclear iron (III)-hydroxide in sucrose for intravenous use. Following intravenous administration, iron sucrose is dissociated by the reticuloendothelial system into iron and sucrose; the sucrose component is eliminated mainly by urinary excretion. Iron sucrose can be administered with or without erythropoietin to raise hemoglobin levels and may be used in cases of oral iron therapy intolerance or ineffectiveness. Hypersensitivity reactions are less common with iron sucrose compared to other parenteral iron products, such as iron dextran. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=467930&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=467930&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C60883" NCI Thesaurus) |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| English | Iron Sucrose Injection, Iron Sucrose for Injection, iron sucrose injection, Iron Saccharate Injection, Ferric Hydroxide Saccharate Injection, Intravenous Ferric Hydroxide Saccharate |
