Iron dextran injection is available as a dark brown liquid complex of ferric hydroxide and dextran in 2-mL single-dose vials.3575 Each mL contains the equivalent of 50 mg of elemental iron in sodium chloride approximately 0.9% and water for injection.3575 Sodium hydroxide and/or hydrochloric acid may have been used to adjust the pH.3575
pH
The pH of the solution ranges from 4.5 to 7.3575
Trade Name(s)
INFeD
Iron dextran is administered intravenously and intramuscularly.3575 With either route of administration, a test dose should be administered prior to the first therapeutic dose.3575
Iron dextran may be administered undiluted by slow intravenous injection.3575 A test dose of 0.5 mL (25 mg of elemental iron) should be administered at a gradual rate over at least 30 seconds prior to the first therapeutic dose of iron dextran.3575 If no signs or symptoms of anaphylactic-type reactions have occurred after a period of at least one hour has elapsed, the remainder of the initial therapeutic dose (i.e., the therapeutic dose less the test dose) may be administered at a slow, gradual rate of no more than 1 mL (50 mg of elemental iron)/min.3575
Iron dextran also may be administered by deep intramuscular injection into the upper outer quadrant of the buttock using a 2- or 3-inch, 19- or 20-gauge needle.3575 Staining of the skin associated with inadvertent injection or leakage of the drug into the subcutaneous tissue can be minimized by displacing the skin laterally prior to intramuscular injection (i.e., Z-track technique).3575 A test dose of 0.5 mL (25 mg of elemental iron) should be administered in the buttock prior to the first therapeutic dose of iron dextran.3575 If no signs or symptoms of anaphylactic-type reactions have occurred after a period of at least one hour has elapsed, the remainder of the initial therapeutic dose (i.e., the therapeutic dose less the test dose) may be administered.3575 Subsequent injections should be made into alternate buttocks.3575
Iron dextran also has been administered by intravenous infusion over 1 to 6 hours after dilution in sodium chloride 0.9% (e.g., 1 g diluted in 250 mL of sodium chloride 0.9% administered over 1 hour).3576; 3577; 3578; 3579; 3580
Dilution in dextrose 5% results in a greater incidence of pain and phlebitis.75 The manufacturer recommends not adding iron dextran injection to parenteral nutrition solutions,3575 especially 3-in-1 mixtures.1814
Intact vials of iron dextran injection should be stored at controlled room temperature.3575
Filtration
Iron dextran adsorbs to sterilizing membrane filters composed of cellulose nitrate and acetate combined. An iron dextran solution containing 5 mcg/mL in water was estimated to lose 93% of the iron from the first mL passed through the filter. As more solution was passed through the filter, a decreasing proportion of the iron was adsorbed, indicating that the filter was approaching saturation. The extent of iron adsorption increased in the presence of electrolytes and trace elements. Adsorption can be substantial, especially when small amounts of iron dextran are involved.918
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