Iron dextran total dose infusion

Age is a possible risk factor regarding adverse reactions to total-dose infusions of iron dextran (45). 

Shimada A. Adverse reactions to total-dose infusion of iron dextran. Clin Pharm 1982 l(3) 248-9. 

The safety and efficacy of high-dose IV iron regimens have been evaluated to determine the most cost-effective and efficacious dosing strategies, hon dextran has been safely administered in total dose infusions ranging from 400 mg to 2 g to dialysis patients. Similar high-dose regimens of 500 mg have also been safely administered to... 

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. 

Total replacement doses of IV iron dextran have been given as a single dose, diluted in 250 to 1000 mL normal saline or 5% dextrose in water and infused over 4 to 6 hours. A test dose is still required. The ability to give a total dose infusion is a benefit of iron dextran over the other parenteral iron products. Iron dextran is best utilized when smaller frequent doses of sodium ferric gluconate or iron sucrose are impractical, such as with peritoneal dialysis. 

When hemodialysis patients are started on erythropoietin, oral iron therapy alone generally is insufficient to guarantee an optimal Hb response. It therefore is recommended that sufficient parenteral iron be given to maintain a plasma ferritin level between 100 and 800 jlg/L and a transferrin saturation of 20—50%. One approach is to administer an initial intravenous dose of 200—500 mg, followed by weekly or every-other-week injections of25—100 mg of iron dextran to replace ongoing blood loss. With repeated doses of iron dextran—especially multiple, total-dose infusions such as those sometimes used in the treatment of chronic GI blood loss—accumulations of slowly metabolized iron dextran stores in reticuloendothelial cells can be impressive. The plasma ferritin level also can rise to levels associated with iron overload. While disease-related hemochromatosis has been associated with an increased risk of infections and cardiovascular disease, this has not been shown to be true in hemodialysis patients treated with iron dextran. It seems prudent, however, to withhold the drug if the plasma ferritin exceeds 800 jlg/L. 

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. 

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. 

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