Adult Dosing
Iron deficiency anemia
- Start 0.5 mL (25 mg) IM/IV test dose given 1 hr prior to therapy
- Total dose in mL = [0.0442 × LBW × (desired Hb - observed Hb)] + (0.26 x LBW)
- Max dose: 100 mg/dose
Iron replacement
- Start 0.5 mL (25 mg) IM/IV test dose given 1 hr prior to therapy
- Total dose (mg) = Blood loss (mL) x hematocrit
- Max: 100 mg/dose
Notes:
- LBW: Lean body weight in kg
- Males: LBW = 50 kg + 2.3 kg for each inch of patient's height over 5 ft
- Females: LBW= 45.5 kg + 2.3 kg for each inch of patient's height over 5 ft
- Do not mix iron dextran with other medications or add to parenteral nutrition solutions for intravenous infusion
Pediatric Dosing
- Safety and effectiveness in pediatric patients <4 months of age have not been established
Iron deficiency anemia
>4 months, 5-15 kgs (11-33 lbs)
- Start 0.25 mL (infants), 0.5 mL (children) IM/IV test dose given 1 hr prior to therapy
- Total dose in mL = [0.0442 × W × (desired Hb - observed Hb)] + (0.26 x W)
- Max: 0.5 mL/dose if wt <5 kgs; 1 mL/dose if wt 5-10 kgs; 2 mL/dose if wt >10 kgs
>4months, >15 kgs
- Start 0.5 mL (25 mg) IM/IV test dose given 1 hr prior to therapy
- Total dose in mL = [0.0442 × LBW × (desired Hb - observed Hb) ] + (0.26 x LBW)
Iron replacement
>4 months
- Start 0.25 mL (infants), 0.5 mL (children) IM/IV test dose given 1 hr prior to therapy
- Total dose (mg) = Blood loss (mL) x hematocrit
- Max: 0.5 mL/dose if wt <5 kgs; 1 mL/dose if wt 5-10 kgs; 2 mL/dose if wt >10 kgs
Notes:
- W: Weight in kg
- LBW: Lean body weight in kg
- Males: LBW = 50 kg + 2.3 kg for each inch of patient's height over 5 ft
- Females: LBW = 45.5 kg + 2.3 kg for each inch of patient's height over 5 ft
- Do not mix iron dextran with other medications or add to parenteral nutrition solutions for intravenous infusion
[Outline]
- Anaphylactic-type reactions, including fatal reactions, are associated with parenteral iron dextran. Administer where resuscitation equipments and personnel trained in treatment of anaphylactic-type reactions are readily available [US Black Box Warning]
- Administer test dose prior to first therapeutic dose; continue with full therapeutic dose if no signs/symptoms of anaphylactic-type reactions occur. Observe for signs/symptoms suggestive of anaphylactic-type reactions during all injections. Fatal reactions have occurred following test dose and even when test dose was tolerated [US Black Box Warning]
- Use only if clinical and laboratory investigations have confirmed iron deficient state not amenable to oral iron therapy [US Black Box Warning]
- Patients with a history of drug allergy or multiple drug allergies may be at increased risk of anaphylactic reactions [US Black Box Warning]
- Concomitant use of angiotensin-converting enzyme inhibitor drugs may increase the risk for reactions to an iron dextran product
- Large IV doses, such as total dose infusions (TDI), have been associated with an increased incidence of adverse events such as arthralgia, backache, chills, dizziness, moderate to high fever, headache, malaise, myalgia, nausea, and vomiting. The adverse reactions are usually delayed 1 to 2 days after administration and symptoms usually subside within 3 to 4 days
- Contraindicated in patients with acute phase of infectious kidney disease
- Iron dextran may exacerbate CV complications in patients with preexisting CV disease
- Risk of carcinogenesis may attend the IM injection of iron-carbohydrate complexes, and these complexes have been found to produce sarcoma in experimental animals when administered in large doses or small doses injected repeatedly at the same site
- Several cases have been reported with tumors at the injection site in humans who had previously received IM injections of iron-carbohydrate complexes
- Unwarranted therapy with parenteral iron will cause excess storage of iron and possibly cause exogenous hemosiderosis, especially in patients with hemoglobinopathies and other refractory anemias
- Use with caution in patients with history of significant allergies or asthma
- Hypersensitivity, including anaphylaxis, may occur. Epinephrine should be immediately available in such acute hypersensitivity reactions
- Acute exacerbation of joint pain and swelling after IV administration have been seen in iron deficiency patients with rheumatoid arthritis
- Ensure to determine hemoglobin, hematocrit, serum ferritin, and transferrin saturation before starting therapy and periodically during treatment
Cautions: Use cautiously in
- Serious hepatic impairment
Pregnancy Category:C
Breastfeeding: Excreted in breast milk in trace amounts. Manufacturer advises caution.
US Trade Name(s)
US Availability
Dexferrum, INFeD, Proferdex
- INJ: 50 mg/mL (2 mL vials)
Canadian Trade Name(s)
Canadian Availability
Dexiron, Infufer
UK Trade Name(s)
UK Availability
CosmoFer
- INJ: 50 mg/mL (2, 5, 10 mL amp)
Australian Trade Name(s)
Australian Availability
[Outline]