Iron dextran injection

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. 

Volume of iron dextran injection may be calculated as follows ... 

The parenteral use of complexes of iron and carbohydrates has resulted in anaphylactic-type reactions. Deaths associated with such administration have been reported therefore, use iron dextran injection only in those patients in whom the indications have been clearly established and laboratory investigations confirm an iron-deficient state not amenable to oral iron therapy. Because fatal anaphylactic reactions have been reported after administration of iron dextran injection, administer the drug only when resuscitation techniques and treatment of anaphylactic and anaphylactoid shock are readily available. 

Hypersensitivity reactions Anaphylaxis and other hypersensitivity reactions have been reported after uneventful test doses as well as therapeutic doses of iron dextran injection. Therefore, consider administration of subsequent test doses during therapy. Have epinephrine immediately available in the event of acute hypersensitivity reactions. 

If blood grouping is to be performed, samples should be taken before the intravenous iron dextran injection, since it interferes with the reaction. 

Newsom L, Erstad BL, Nakazato PZ, Daller JA. Falsely decreased total serum calcium concentration associated with iron dextran injection. Pharmacotherapy 1995 15(6) 789-92. 

Iron dextran injection contains a complex of iron hydroxide with dextrans of average molecular weight between 5000 and 7000, and is used for the... 

Equations for calculating the appropriate dose of parenteral iron in patients with IDA or those with anemia secondary to blood loss can be found in Table 99-7. When given by IV administration, the dose should not exceed 50 mg of iron per minute (1 mL/min). It is suggested that all patients considered for an iron dextran injection receive a test dose of 25 mg IM or IV, or a 5- to 10-minute infusion of the diluted solution. Patients should then be observed for more than 1 hour for untoward reactions. If an anaphylaxis-like reaction were to occur, it generally responds to IV epinephrine, diphenhydramine, and corticosteroids. Patients receiving total dose infusions can have the remaining solution infused during the next 2 to 6 hours if the test dose is tolerated. 

Iron dextran injection (INFED, DEXFERRUM) is a colloidal solution of ferric oxyhydroxide com-plexed with polymerized dextran (molecular weight -ISO IcDa) that contains 50 mg/mL of elemental iron. It can be administered by either intravenous (preferred) or intramuscular injection. When given by deep intramuscular injection, it is gradually mobilized via the lymphatics and transported to reticuloendothelial cells the iron then is released from the dextran complex. Intravenous administration gives a more reliable response. Given intravenously in a dose of less than 500 mg, the iron dextran complex is cleared with a plasma tj of 6 hours. When I g or more is administered intravenously as total dose therapy, reticuloendothelial cell clearance is constant at 10-20 mg/h. This slow rate of clearance results in a brownish discoloration of the plasma for several days and an elevation of the serum iron for 1-2 weeks. 

Anon5mious. Iron dextran injection. Change in boxed warning. WHO Newslett 2010 1 6. 

It is common practice not to add iron to TPN solutions because of the possibility of physical incompatibility and the risk of anaphylaxis when iron-dextran preparations are used. Fatal anaphylactic reaction secondary to intramuscular iron dextran injections (Becker et al, 1966), as well as other local and systemic reactions following intravenous administration, particularly using the bolus dosage method, have been described (Hamstra et al., 1980). Yet many recent reports attest to the low frequency of the above complications and the apparent safety of using lower doses in nutrient solutions for adults and children (Hamstra et al., 1980 Gilbert et al., 1979 Figueredo and Kaminski, 1979 Halpin et al., 1980 Peters et al, 1980 Reed et al, 1981). Similarly, physical incompatibility problems are less common with the lower doses and lower iron concentrations. As an alternative iron source, ferrous citrate may prove to be a more suitable intravenous iron supplement than dextran (Sayers et al, 1983). 

Reed, M. D., Bertino, J. S., and Halpin, T.C., 1981, Use of intravenous iron dextran injection in children receiving total parenteral nutrition. Am. J. Dis. Child. 135 829. 

Lazaro, F.J. Abadia, A.R. Romero, M.S. Gutierrez, L. Lazaro, J. Morales, M.P. (2005), Magnetic characterisation of rat muscle tissues after subcutaneous iron dextran injection. Biochim. Biophys. Acta - Mol. Basis Dis., 1740 434-445. 

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. 

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 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)... 

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... 

Figure 4. Accumulation of iron-labeled MSC in the renal cortex. Animals were anesthetized and coronal T 2-weighted gradient echo in vivo magnetic resonance images (MRl) were obtained before (A) and immediately (B) or 3 days (C) after injection of magnetically labeled (iron-dextran) syngeneic mesenchymal stem cells.

Absorption/Distribution - The major portion of IM injections of iron dextran is absorbed within 72 hours most of the remaining iron is absorbed over the ensuing 3 to 4 weeks. Various studies have yielded half-life values ranging from 5 hours (circulating iron dextran) to more than 20 hours (total iron, both circulating and bound). 

Iron dextran is a stable complex of ferric oxyhydroxide and dextran polymers containing 50 mg of elemental iron per milliliter of solution. It can be given by deep intramuscular injection or by intravenous infusion, although the intravenous route is used most commonly. Intravenous administration eliminates the local pain and tissue staining that often occur... 

Large doses of intravenous iron dextran and iron saccha-rate have been compared in a retrospective study of 379 patients who had attended peritoneal dialysis clinics in the past 5 years (12). Of these, 62 were selected to receive intravenous iron based on ferrokinetic markers of iron deficiency, non-adherence to oral iron, ineffectiveness of oral iron, or increased erythropoietin requirements. Intravenous iron was given as two injections of 500 mg each 1 week apart in 61 patients, 33 of whom received iron dextran, 23 iron saccharate, and five both iron dextran and iron saccha-rate. One patient developed anaphylaxis to a test dose of iron dextran and was excluded from further therapy. Blood samples were collected before and 3 and 6 months after iron infusions. Five of the 34 patients who received iron dextran developed minor adverse effects and one had an anaphylactic reaction to the test dose. Of the 23 patients who received iron saccharate, one had an anaphylactic reaction and two had transient chest pain, which subsided without therapy. There were more adverse effects with iron dextran (7.4% of injections) compared with iron saccharate (4.3% of injections), but this difference was not statistically significant. The number of episodes of peritonitis also increased during the 6 months after intravenous iron infusion, especially with iron dextran, compared with the number of episodes during the 6 months before iron infusions, although the difference was not statistically significant. 

Iron-dextran complexes are soluble, nonionic and suitable for injection for the treatment of anaemia the complex is stable on storage in the pH range 4-11. More recently aminoethyldextran-methotrexate complexes have been prepared, the object being to influence uptake of the dmg selectively into tumour cells. Attachment of the dmg to the macromolecule allows selective uptake into malignant cells, as such cells are more active than normal cells in pinocytosis, the mechanism by which macromolecules are taken into many cells. 

The iron dextran package insert carries a black box warning regarding the risk of anaphylaxis and requires a test dose before administration of the repletion dose. Methods of IV administration include multiple slow injections of undiluted iron dextran solution or an infusion of a diluted preparation. This latter method is often referred... 

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