Routine use is usually not justified, unless used in renal failure patients on dialysis.
Indications are:
— Malabsorption
— Intolerance to oral iron preparations (colitis, enteritis)
— Need in excess of amount that can be given orally
— Preoperative autologous blood donation
— Patient uncooperative or unavailable for follow-up
— Renal failure patients on dialysis
High-molecular-weight iron dextran (Dexferrum)
— This is the first such agent available in the United States.
— It can be given in higher single administration than other iron preparations.
— Be aware of the danger of anaphylaxis or other systemic side effects (Food and Drug Administration [FDA] Black Box Warning).
— Severe reactions are more common than with other parenteral preparations listed below.
— This preparation contains 50 mg elemental iron per mL, with approximately 70% readily available for hemoglobin synthesis.
— It may be given intramuscularly or intravenously.
— See Williams Hematology, 9th ed, Chap. 43 or product information sheet for dosage calculations.
Low-molecular-weight iron dextran (InFeD, CosmoFer)
— This has a lower risk of drug reactions but still retains an FDA Black Box Warning.
Iron sucrose (Venofer)
— This is a complex of polynuclear iron ferric hydroxide in sucrose.
— The manufacturer’s recommended dose is 5 mL (100 mg of elemental iron).
— Adverse events are reported by more than 5% of treated patients, with hypotension the most common.
Ferric gluconate complex in sucrose (Ferrlecit)
— This is a macromolecular complex of ferric iron.
— The manufacturer recommends administration of doses of 125 mg of elemental iron with the preparation diluted in 100 mL of 0.9% sodium chloride and given intravenously over 1 hour.
— Adverse events are reported by more than 5% of treated patients, with hypotension the most common.
Ferumoxytol (Feraheme)
— This intravenous iron preparation is approved for treatment of the anemia of chronic kidney disease.
— It is a carbohydrate-coated, superparamagnetic iron oxide nanoparticle.
— Clinical experience is limited. Approved in 2010, it received an FDA-mandated Black Box Warning in 2015 because of reports of serious reactions.