Iron dextran

Iron dextran is a parenteral iron that is also used for die treatment of iron deficiency anemia It is primarily used when the patient cannot take oral drugs or when the patient experiences gastrointestinal intolerance to oral iron administration. Other iron preparations, both oral and parenteral, used in the treatment of iron deficiency anemia can be found in the Summary Drug Table Dragp Used in the Treatment of Anemia... 

Iron salts occasionally cause gastrointestinal irritation, nausea, vomiting, constipation, diarrhea, headache, backache, and allergic reactions. The stools usually appear darker (black). Iron dextran is given by the parenteral route Hypersensitivity reactions, including fatal anaphylactic reactions, have been reported with the use of this form of iron. Additional adverse reactions include soreness, inflammation, and sterile abscesses at the intramuscular (IM) injection site Intravenous (IV) administration may result in phlebitis at the injection site When iron is administered via the IM route, a brownish discoloration of tlie skin may occur. Fhtients with rheumatoid arthritis may experience an acute exacerbation of joint pain, and swelling may occur when iron dextran is administered. 

The absorption of oral iron is decreased when tlie agent is administered with antacids, tetracyclines, penicillamine, and the fluoroquinolones. When iron is administered with levothyroxine, there may be a decrease in tlie effectiveness of levothyroxine When administered orally, iron deceases the absoqition of lev-odopa. Ascorbic acid increases tlie absoqition of oral iron. Iron dextran administered concurrently with chloramphenicol increases serum iron levels. 

If iron dextran is administered, the nurse informs die patient that soreness at the injection site may occur. Injection sites are checked daily for signs of inflammation, swelling, or abscess formation. 

Iron dextran is given via the IM or IV route. Before iron dextran is administered, a test dose may be done by... 

FIGURE 45-1. Administering iron dextran using the Z-track technique. 

Monitoring and Managing Adverse Reactions When tiie patient is receiving iron dextran, the nurse monitors closely for a hypersensitivity reaction. Epinephrine is kept on standby in tiie event of severe anaphylactic reaction. 

Fhtients with rheumatoid arthritis may experience an acute exacerbation of joint pain, and swelling may occur with iron dextran therapy. 

Beryllium and certain compounds Cadmium and certain compounds Carbon tetrachloride Chlorambucil Cyclophosphamide Dimethylcarbamoyl chloride Dimethyl sulphate Ethylene oxide Iron dextran... 

Iron dextran injection contains a complex of iron hydroxide with dextrans of average molecular weight between 5000 and 7000, and is used for the treatment of iron-defieiency anaemia in situations where oral therapy is ineffeetive or impractical. The sodium salt of sulphurie aeid esters of dextran, i.e. dextran sodium sulphate, has anti-eoagulant properties eomparable with heparin and is formulated as an injection for intravenous use. 

Iron Dextran 5000- 7500 (complex with ferric chloride) Colloidal solution In 0.9% w/v sodium chloride injection Autoclave Deep IM non-deficiency anaemia (oral therapy ineffective or impractical) IV (slow infusion) non-deficiency anaemia (oral therapy ineffective or impractical)... 

Winyard, P.G., Blake, D.R., Chirco, S., Gutteridge, J.M.C. and Lunec, J. (1987a). Mechanism of exacerbation of rheumatoid synovitis by total-dose iron-dextran infusion in vivo demonstration of iron-promoted oxidant stress. Lancet i, 69-72. 

Oral iron supplementation is generally not effective in maintaining adequate iron stores in patients receiving ESAs because of poor absorption and an increased need for iron with ESA therapy, making the IV route necessary for iron supplementation. The IV iron products currently available are iron dextran (distributed as INFeD by Watson Pharmaceuticals, Inc., Morristown, NJ, and Dexferrum by American Reagent, Inc.,... 

When replacing iron stores in patients receiving ESA therapy, the general approach to treatment is to give a total of 1 g of IV iron, administered in smaller, sequential doses. Because iron stores deplete quickly in patients who do not receive iron supplementation, maintenance doses are often used, particularly in patients receiving hemodialysis. Maintenance doses consist of smaller doses of iron administered weekly or with each dialysis session (e.g., iron dextran or iron sucrose 20 to 100 mg per week sodium ferric gluconate 62.5 to 125 mg per week). 

Parenteral Formulations Iron dextran InFED 50 mg/tablet 50 mg/mL... 

Parenteral iron therapy currently is available in three different formulations, which are listed in Table 63-3. Iron dex-tran was the first parenteral iron formulation to be approved, followed by ferric gluconate, and then iron sucrose. Although these newer agents are only approved by the Food and Drug Administration (FDA) to treat anemia associated with CKD in patients receiving erythropoietin products, they are effective in treating iron-deficiency anemia as well. Iron dextran is FDA approved for treating documented iron deficiency in patients who are unable to tolerate the oral formulation. 

Parenteral iron anaphylaxis (test dose required for iron dextran and observe for 1 hour after), injection-site pain/ irritation, arthralgias, myalgias, flushing, malaise, and fever... 

Iron-deficiency anemia in chronic PN patients may be due to underlying clinical conditions and the lack of iron supplementation in PN. Parenteral iron therapy becomes necessary in iron-deficient patients who cannot absorb or tolerate oral iron. Parenteral iron should be used with caution owing to infusion-related adverse effects. A test dose of 25 mg of iron dextran should be administered first, and the patient should be monitored for adverse effects for at least 60 minutes. Intravenous iron dextran then may be added to lipid-free PN at a daily dose of 100 mg until the total iron dose is given. Iron dextran is not compatible with intravenous lipid emulsions at therapeutic doses and can cause oiling out of the emulsion. Other parenteral iron formulations (e.g., iron sucrose and ferric gluconate) have not been evaluated for compounding in PN and should not be added to PN formulations. 

Some other examples of free radical formation in various pathologies are discussed below. (Of course, they are only few examples among many others, which can be found in literature.) Mitochondrial diseases are associated with superoxide overproduction [428] and cytochrome c release [429], For example, mitochondrial superoxide production apparently contributes to hippocampal pathology produced by kainate [430]. It has been found that erythrocytes from iron deficiency anemia are more susceptible to oxidative stress than normal cells but have a good capacity for recovery [431]. The beneficial effects of treatment of iron deficiency anemia with iron dextran and iron polymaltose complexes have been shown [432,433]. 

Available parenteral iron preparations have similar efficacy but different pharmacologic, pharmacokinetic, and safety profiles (Table 33-5). The newer products, sodium ferric gluconate and iron sucrose, appear to be better tolerated than iron dextran. 

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