Makindo Medical Notes

Earlier intravenous iron formulations were associated with rare cases of anaphylaxis. However, newer formulations with better safety profiles are now available. Intravenous iron should always be administered in a setting with immediate resuscitation facilities. Equipment for resuscitation and medications such as adrenaline, antihistamines, and corticosteroids must be available.

About

• Intravenous (IV) iron products are used to treat iron deficiency and anaemia when oral iron supplements are ineffective or cannot be tolerated.
• Hypersensitivity reactions, though rare, may occur with IV iron products and can be life-threatening. Product information provides specific warnings about these risks.

Warnings

• All patients must be monitored for anaphylaxis during and after IV iron administration.
• Large doses can be given at one time using iron dextran. Iron sucrose and ferric gluconate require smaller, more frequent doses over several weeks.
• Test doses are no longer recommended; every dose of IV iron should be given with caution.
• Allergic reactions are more common with iron dextran, which may require switching to a different preparation.

IV Iron Preparations

• Iron Dextran (Cosmofer):
  • Administer via intravenous infusion in Glucose 5% or Sodium Chloride 0.9%.
  • Initial dose: 25 mg over 15 minutes, then a rate not exceeding 6.67 mg/min.
  • Total dose infusion: Dilute 100-200 mg in 100 mL infusion fluid and give over 4-6 hours.
• Iron Sucrose (Venofer):
  • Administer via intravenous infusion in Sodium Chloride 0.9%.
  • Initial dose: 25 mg over 15 minutes, then a rate not exceeding 3.33 mg/min.
  • Maximum dose: 100 mg diluted in up to 100 mL infusion fluid.
• Ferric Carboxymaltose (Ferinject):
  • Administer only via intravenous infusion using an infusion pump.
  • Maximum single dose: 1,000 mg (up to 20 mg/kg body weight).
  • Prepare using sterile 0.9% Sodium Chloride solution.

Side Effects

• Allergic Reactions: Anaphylaxis, urticaria (hives), pruritus (itching), muscle and joint pain.
• Common Reactions: Dizziness, flushing, headache, hypertension, hypotension, nausea, altered taste, and hypophosphataemia.
• Para-venous Leakage:
  • Occurs when Ferinject leaks at the injection site, potentially causing irritation and long-lasting brown discoloration.
  • If leakage occurs, stop administration immediately, apply a cold pack to the site, and elevate the affected limb.

Management of Side Effects

• Mild Reactions: Stop infusion, assess the patient, and consider IV antihistamines or hydrocortisone.
• Severe Reactions:
  • Signs: Wheeze, stridor, anaphylaxis, urticaria, hypotension.
  • Management:
    • Stop infusion immediately.
    • Follow ABC (Airway, Breathing, Circulation) protocol.
    • Administer IV hydrocortisone (100 mg).
    • Give IM adrenaline and oxygen in cases of anaphylaxis.