ferumoxytol

Consists of a superparamagnetic iron oxide coated with a carbohydrate shell; when the iron-carbohydrate complex enters the reticuloendothelial system (RES), iron is released from the iron-carbohydrate complex within macrophages. This iron can either enter the intracellular storage iron pool or be transferred to erythroid precursor cells for incorporation into hemoglobin.

Therapeutic effects:

Improvement in anemia.

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability of iron-carbohydrate complex; however, iron is not liberated until incorporation into RES.

Distribution: Taken up by RES.

Metabolism/Excretion: Iron can either become part of intracellular ferritin or be transferred to erythroid precursor cells.

Half-Life: 15 hr.

Time/Action Profile ⬆ ⬇

(effect on anemia)

ROUTE	ONSET	PEAK	DURATION
IV	unknown	unknown	up to 1 mo

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to ferumoxytol or any other IV iron product;
Evidence of iron overload;
Anemia not due to iron deficiency;
Lactation: Lactation.

Use Cautiously in:

MRI;
Multiple drug allergies (↑ risk for anaphylaxis);
OB: Severe hypersensitivity reactions may occur, which can lead to bradycardia in fetus, especially during 2nd and 3rd trimesters;
Pedi: Safety and effectiveness not established in children;
Geri: Consider age-related ↓ in hepatic, renal, or cardiac function, and concurrent diseases or other drug therapy; older adults with multiple comorbidities may experience worse outcomes if develop hypersensitivity reactions.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypertension, HYPOTENSION, peripheral edema

GI: constipation, diarrhea, nausea

Hemat: iron overload

Neuro: dizziness

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

May ↓ absorption of concurrently administered oral iron preparations.

Route/Dosage ⬆ ⬇

IV (Adults ): 510 mg initially, followed by 510 mg 3–8 days later. Course may be repeated after 1 mo.

Availability ⬆ ⬇

(Generic available)

Solution for injection: 30 mg elemental iron/mL

Assessment ⬆ ⬇

Assess nutritional status and dietary history to determine need for patient teaching.
Assess bowel function for constipation or diarrhea. Notify health care provider and use appropriate measures should these occur.
Monitor BP and HR frequently during and for ≥30 min following administration or until stable. May cause hypotension. For patients receiving hemodialysis, administer ferumoxytol once the BP is stable and ≥1 hr of hemodialysis has been completed. Wait ≥30 min after administration before administering other agents that may cause hypersensitivity reactions or hypotension (chemotherapeutic agents or monoclonal antibodies).
Observe patient for signs and symptoms of anaphylaxis (cardiac/cardiorespiratory arrest, clinically significant hypotension, syncope, unresponsiveness, rash, pruritus, urticaria, laryngeal edema, wheezing) during and for ≥30 min following injection. May occur with 1st or subsequent doses. Notify health care provider immediately if these occur. Keep epinephrine and resuscitation equipment close by in the event of an anaphylactic reaction.
Conduct MRI studies prior to administration. Alteration of MRI studies may persist for up to 3 mo following a dose; if imaging is required within 3 mo after administration, use T1- or proton density-weighted MR pulse sequences to decrease effects; MRI using T2-weighted pulse sequences should not be performed earlier than 4 wk after administration; maximum alteration of vascular MRI is evident for 1–2 days after dose. Ferumoxytol does not interfere with x-ray, computed tomography (CT), positron emission tomography (PET), single photon emission computed tomography (SPECT), ultrasound, or nuclear imaging.

Lab Test Considerations:

Monitor hemoglobin, ferritin, iron, and transferrin saturation prior to therapy, ≥1 mo following 2nd dose, and regularly thereafter. Iron and transferrin-bound iron may be overestimated within 1st 24 hr by measuring iron in the Feraheme complex.

Implementation ⬆ ⬇

IV Administration:

Intermittent Infusion: Diluent: Dilute 510 mg in 50–200 mL of 0.9% NaCl or D5W. Concentration: 2–8 mg/mL. Do not administer solutions that are discolored or contain particulate matter. Solution may be stored at room temperature for up to 4 hr and refrigerated for up to 48 hr.
Rate: Infuse over 15 min while patient is in a reclining or semireclining position.
Y-Site Incompatibility: Do not administer other drugs through same IV line.

Patient/Family Teaching ⬆ ⬇

Explain purpose of iron therapy to patient.
Advise patients to avoid MRI studies during and for 3 mo following ferumoxytol therapy.
May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Advise patient to report signs and symptoms of hypersensitivity reactions (rash, itching, wheezing, dizziness, swelling, breathing problems) to health care provider immediately.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Severe maternal reactions (circulatory failure, severe hypotension, shock, anaphylaxis) may occur increasing risk for preterm delivery and low birth weight. May cause fetal bradycardia, especially in 2nd and 3rd trimester.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇