Iron Dextran Complex

1-10%

Abdominal pain

Diarrhea

Nausea

Vomiting

Arthralgia

Arthritis

Soreness

Inflammation

Pruritus

Rash

Urticaria

Brown discoloration of skin

Frequency Not Defined

Seizure

Chest pain

Hypotensive shock

Dyspnea

Respiratory arrest

Leukocytosis

Anaphylaxis

Hematuria

• Tell all of your health care providers that you take this medicine. This includes your doctors, nurses, pharmacists, and dentists.
• Have blood work checked as you have been told by the doctor. Talk with the doctor.
• This medicine may affect certain lab tests. Tell all of your health care providers and lab workers that you take iron dextran complex.
• Do not take other iron products with this medicine.
• Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using iron dextran complex while you are pregnant.
• Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.

(EYE ern DEKS tran KOM pleks)

• High-Molecular-Weight Iron Dextran (DexFerrum)
• Imferon
• Iron Dextran
• Low-Molecular-Weight Iron Dextran (INFeD)

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

Absorption

IM: 60% absorbed after 3 days; 90% after 1 to 3 weeks, the balance is slowly absorbed over months

IV: Uptake of iron by the reticuloendothelial system appears to be constant at about 10 to 20 mg/hour

Excretion

Urine and feces via reticuloendothelial system

Hematologic response to either oral or parenteral iron salts is essentially the same; red blood cell form and color changes within 3 to 10 days

Maximum effect: Peak reticulocytosis occurs in 5 to 10 days, and hemoglobin values increase within 2 to 4 weeks; serum ferritin peak: 7 to 9 days after IV dose

Half-Life Elimination

48 hours

Note: Dexferrum has been discontinued in the US for more than 1 year.

Note: A 0.5 mL test dose should be given prior to starting iron dextran therapy.

Iron-deficiency anemia: IM (INFeD), IV (Dexferrum, INFeD):

Dose (mL) = 0.0442 (desired hemoglobin - observed hemoglobin) x LBW + (0.26 x LBW)

Desired hemoglobin: Usually 14.8 g/dL

LBW = Lean body weight in kg

Iron replacement therapy for blood loss: (INFeD), IV (Dexferrum, INFeD): Replacement iron (mg) = blood loss (mL) x Hct

Maximum daily dosage: Manufacturer's labeling: Note: Replacement of larger estimated iron deficits may be achieved by serial administration of smaller incremental dosages. Daily dosages should be limited to 100 mg iron (2 mL)

Cancer-/chemotherapy-associated anemia: IV: Note: Use the iron-deficiency anemia equation for determining a calculated dose, when applicable.

Weekly administration (off-label dosing; INFed):

Weeks 1-3: Test dose of 25 mg (over 1-2 minutes), followed by 75 mg (bolus) once weekly

Weeks 4 and after: 100 mg over 5 minutes once weekly until the calculated dose is reached (Auerbach, 2004)

or

Week 1: Test dose of 25 mg (slow IV push), followed 1 hour later by 75 mg over 5 minutes

Weeks 2-10: 100 mg over 5 minutes once weekly for a total cumulative dose of 1000 mg (NCCN anemia guidelines v.2.2014)

Total dose infusion (off-label dosing; INFeD):

Test dose of 25 mg (over 1-2 minutes), followed 1 hour later by the balance of the calculated total dose mixed in 500 mL NS and infused at 175 mL/hour (Auerbach, 2004)

or

Test dose of 25 mg (slow IV push) followed 1 hour later by the balance of the total dose as a single infusion over several hours; if calculated dose exceeds 1000 mg, administer remaining dose in excess of 1000 mg after 4 weeks if inadequate hemoglobin response (NCCN anemia guidelines v.2.2014)

Refer to adult dosing.

Solutions for infusion should be diluted in 250-1000 mL NS.

ACE Inhibitors: May enhance the adverse/toxic effect of Iron Dextran Complex. Specifically, patients receiving an ACE inhibitor may be at an increased risk for anaphylactic-type reactions. Management: Follow iron dextran recommendations closely regarding both having resuscitation equipment and trained personnel on-hand prior to iron dextran administration and the use of a test dose prior to the first therapeutic dose. Consider therapy modification

Dimercaprol: May enhance the nephrotoxic effect of Iron Salts. Avoid combination

Entacapone: Iron Salts may decrease the serum concentration of Entacapone. Management: Consider separating doses of the agents by 2 or more hours to minimize the effects of this interaction. Monitor for decreased therapeutic effects of levodopa during concomitant therapy, particularly if doses cannot be separated. Consider therapy modification