Yes

Iron Salt

Treatment of microcytic hypochromic anemia resulting from iron deficiency in whom oral administration is infeasible or ineffective

C

Hypersensitivity to iron dextran, all anemias that are not involved with iron deficiency, hemochromatosis, hemolytic anemia

Use with caution in patients with history of asthma, hepatic impairment, rheumatoid arthritis; not recommended in children <4 months of age; deaths associated with parenteral administration following anaphylactic-type reactions have been reported; use only in patients where the iron deficient state is not amenable to oral iron therapy. A test dose of 0.5 mL I.V. or I.M. should be given to observe for adverse reactions. Anemia in the elderly is often caused by "anemia of chronic disease" or associated with inflammation rather than blood loss. Iron stores are usually normal or increased, with a serum ferritin >50 ng/mL and a decreased total iron binding capacity. I.V. administration of iron dextran is often preferred over I.M. in the elderly secondary to a decreased muscle mass and the need for daily injections.

>10%:

Cardiovascular: Flushing

Central nervous system: Dizziness, fever, headache, pain

Gastrointestinal: Nausea, vomiting, metallic taste

Local: Staining of skin at the site of I.M. injection

Miscellaneous: Diaphoresis

1% to 10%:

Cardiovascular: Hypotension (1% to 2%)

Dermatologic: Urticaria (1% to 2%), phlebitis (1% to 2%)

Gastrointestinal: Diarrhea

Genitourinary: Discoloration of urine

<1%: Cardiovascular collapse, leukocytosis, chills, arthralgia, respiratory difficulty, lymphadenopathy

Note: Diaphoresis, urticaria, arthralgia, fever, chills, dizziness, headache, and nausea may be delayed 24-48 hours after I.V. administration or 3-4 days after I.M. administration

Anaphylactoid reactions: Respiratory difficulties and cardiovascular collapse have been reported and occur most frequently within the first several minutes of administration

Symptoms of overdose include erosion of GI mucosa, pulmonary edema, hyperthermia, convulsions, tachycardia, hepatic and renal impairment, coma, hematemesis, lethargy, tachycardia, acidosis, serum Fe level >300 mcg/mL requires treatment of overdose due to severe toxicity

Although rare, if a severe iron overdose (when the serum iron concentration exceeds the total iron-binding capacity) occurs, it may be treated with deferoxamine. Deferoxamine may be administered I.V. (80 mg/kg over 24 hours) or I.M. (40-90 mg/kg every 8 hours).

Decreased effect with chloramphenicol

Store at room temperature

Standard diluent: Dose/250-1000 mL NS

Minimum volume: 250 mL NS

The released iron, from the plasma, eventually replenishes the depleted iron stores in the bone marrow where it is incorporated into hemoglobin

Absorption:

I.M.: 50% to 90% is promptly absorbed, the balance is slowly absorbed over month

I.V.: Uptake of iron by the reticuloendothelial system appears to be constant at about 10-20 mg/hour

Elimination: By the reticuloendothelial system and excreted in the urine and feces (via bile)

I.M. (Z-track method should be used for I.M. injection), I.V.:

Iron deficiency anemia: Dose (mL) = 0.0476 x wt (kg) x (normal hemoglobin - observed hemoglobin) + (1 mL/5 kg) to maximum of 14 mL for iron stores

Iron replacement therapy for blood loss: Replacement iron (mg) = blood loss (mL) x hematocrit

Maximum daily dose (can administer total dose at one time I.V.):

Infants <5 kg: 25 mg iron (0.5 mL)

Children:

5-10 kg: 50 mg iron (1 mL)

10-50 kg: 100 mg iron (2 mL)

Adults >50 kg: 100 mg iron (2 mL)

Hemoglobin, hematocrit, reticulocyte count, serum ferritin

Hemoglobin 14.8 mg % (for weight >15 kg), hemoglobin 12.0 mg % (for weight <15 kg)

Serum iron: 40-160 mg/dL

Total iron binding capacity: 230-430 mg/dL

Transferrin: 204-360 mg/dL

Percent transferrin saturation: 20% to 50%

May cause falsely elevated values of serum bilirubin and falsely decreased values of serum calcium

May cause dizziness

None reported

No information available to require special precautions

No effects or complications reported

You will need frequent blood tests while on this therapy. If you have rheumatoid arthritis you may experience increased swelling or joint pain; consult prescriber for medication adjustment. If you experience dizziness or severe headache, use caution when driving or engaging in tasks that require alertness until response to drug is known. Small frequent meals, frequent mouth care, sucking lozenges, or chewing gum may relieve nausea and metallic taste. You may experience increased sweating. Report acute GI problems, fever, difficulty breathing, rapid heartbeat, yellowing of skin or eyes, or swelling of hands and feet. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Do not breast-feed.

I.M.: Use Z-track technique for I.M. administration (deep into the upper outer quadrant of buttock)

I.V.: Direct I.V. push administration is not recommended; dilute in normal saline (250-1000 mL) and infuse over 1-6 hours at a maximum rate of 50 mg/minute; avoid dilution in dextrose due to an increased incidence of local pain and phlebitis

Injection: 50 mg/mL (2 mL, 10 mL)

Auerbach M, Witt D, and Toler W, "Clinical Use of the Total Dose Intravenous Infusion of Iron Dextran," J Lab Clin Med, 1988, 111(5):566-70.

Benito RP and Guerrero TC, "Response to a Single Intravenous Dose Versus Multiple Intramuscular Administration of Iron Dextran Complex: A Comparative Study," Curr Ther Res Clin Exp, 1973, 15(7):373-82.

Lipschitz DA, "The Anemia of Chronic Disease," J Am Geriatr Soc, 1990, 38(11):1258-64.