Parenteral iron

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... 

Parenteral iron has resulted in fatal anaphylactic-type reactions The nurse reportsany of the following adverse reactions dyspnea, urticaria, rashes itching, and fever. 

Less blood loss and iron deficiency, resulting in easier management of anemia or reduced requirements for erythropoietin and parenteral iron. 

Compare and contrast the various oral and parenteral iron preparations. 

In patients with iron-deficiency anemia, appropriate oral iron therapy that delivers sufficient elemental iron should be administered before giving parenteral iron. 

Parenteral iron therapy may be appropriate in cases where patients are unable to tolerate the oral formulation because of toxicities or compliance. In addition, those who have documented iron-deficiency anemia and have not responded to... 

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. 

Calculate this patient s dose of parenteral iron. 

What adverse effects are associated with parenteral iron ... 

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... 

Silverstein SB, Rodgers GM. Parenteral iron therapy options. Am J Hematol 2004 76(l) 74-78. 

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. 

Iatrogenic causes long-term non-indicated (parenteral) iron therapy... 

Parenteral iron may be required for patients with iron malabsorption, intolerance of oral iron therapy, or noncompliance. Parenteral administra-... 

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. 

TABLE 33-4 Equations for Calculating Doses of Parenteral Iron ... 

In patients with anemia of critical illness, parenteral iron is often utilized but is associated with a theoretical risk of infection. Routine use of epoetin alfa or RBC transfusions is not supported by clinical studies. 

Iron supplementation is necessary to replete iron stores (Fig. 76-5). Parenteral iron therapy improves response to erythropoietic therapy and reduces the dose required to achieve and maintain target indices. In contrast, oral therapy is often inadequate. 

Iron overload Unwarranted therapy with parenteral iron will cause excess storage of iron with the consequent possibility of exogenous hemosiderosis. 

Drug interactions involving iron sucrose have not been studied. However, like other parenteral iron preparations, iron sucrose may be expected to reduce the absorption of concomitantly administered oral iron preparations. Do not administer concomitantly with oral iron preparations. 

Oral Iron preparations Coadministration of parenteral iron preparations may reduce absorption of oral iron preparations. 

Indications for use of parenteral iron, e.g. as fer-rioxidesaccharate or iron dextran, are in patients on hemodialysis and patients with a disease which prevents absorption from the gastrointestinal tract, in patients who are on long term parenteral nutrition and sometimes in patients with inflammatory bowel disease. Parenteral iron does not raise the hemoglobin level significantly faster than oral therapy and carries a risk of severe adverse reactions. Reactions to intravenous iron include headache, malaise, fever, arthralgias, urticaria and in rare cases anaphylactic reactions, which may be fatal. 

The symptoms of iron deficiency anemia include fatigue, weakness, shortness of breath, and soreness of the tongue. Therapeutic iron supplementation is used to treat this type of anemia. Oral administration of ferrous salts (generic ferrous sulfate, Feosol, Slo Fe) is preferred, but parenteral iron (iron dextran, InfeD) can be given if oral therapy fails. Toxic reactions occur more frequently after parenteral iron administration. Gastrointestinal disturbances are common following oral dosages. 

Iron deficiency anemia is treated with oral or parenteral iron preparations. Oral iron corrects the anemia just as rapidly and completely as parenteral iron in most cases if iron absorption from the gastrointestinal tract is normal. An exception is the high requirement for iron of patients with advanced chronic kidney disease who are undergoing hemodialysis and treatment with erythropoietin for these patients, parenteral iron administration is preferred. 

The challenge with parenteral iron therapy is that parenteral administration of inorganic free ferric iron produces serious dose-dependent toxicity, which severely limits the dose of that can be administered. However, when the ferric iron is formulated as a colloid containing particles with a core of iron oxyhydroxide surrounded by a core of carbohydrate, bioactive iron is released slowly from the stable colloid particles. In the USA, the three available forms of parenteral iron are iron dextran, sodium ferric gluconate complex, and iron sucrose. 

Sodium ferric gluconate complex and iron-sucrose complex are alternative parenteral iron preparations. These agents can be given only by the intravenous route. They appear to be less likely than high-molecular-weight iron dextran to cause hypersensitivity reactions. 

For patients who are treated chronically with parenteral iron, it is important to monitor iron storage levels to avoid the serious toxicity associated with iron overload. Unlike oral iron therapy, which is subject to the regulatory mechanism provided by the intestinal uptake system, parenteral administration, which bypasses this regulatory system, can deliver more iron than can be safely stored. Iron stores can be estimated on the basis of serum concentrations of ferritin and the transferrin saturation, which is the ratio of the total serum iron concentration to the total iron-binding capacity ( ). 

Parenteral (Iron dextran) (InFeD, DexFerrum) 50 mg elemental iron/mL Parenteral (Sodium ferric gluconate complex) (Ferrlecit) 12.5 mg elemental iron/mL Parenteral (Iron sucrose) (Venofer) 20 mg elemental iron/mL Oprelvekin (IL-11) (Neumega)... 

Owing to the risk of a hypersensitivity reaction, a small test dose of iron dextran should always be given before full intramuscular or intravenous doses are given. Patients with a strong history of allergy and patients who have previously received parenteral iron are more likely to have hypersensitivity reactions following treatment with parenteral iron dextran. 

Diet plays a significant role because iron is poorly absorbed from vegetables, grain products, dairy products, and eggs iron is best absorbed fi om meat, fish, and poultry. Administration of iron therapy with a meal decreases absorption hy more than 50% but may be needed to improve tolerabiUty. Parenteral iron may be required for patients with iron malabsorption, intolerance of oral iron therapy, or noncompliance. Parenteral administra-... 

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