iron dextran (INFeD, Imferon, Dexferrum)

Introduction

Tradenames: Imferon, Infed, Dexferrum.

Indications

• treatment of iron deficiency when oral treatment is not feasible or ineffective

Contraindications

pregnancy category: -

safety in lactation: ?

Dosage

• a test dose of 0.5 mL should be given prior to standard therapy (0.25 mL infants)
• diphenhydramine & epinephrine should be immediately available
• a Z-track method should be used for IM injection
• IM administration is painful & should be given in a large muscle such as the gluteus maximus
• iron-deficiency anemia
  • infusion over 4 hours:
  • maximum daily dose:* 100 mg of iron (2 mL)
  • total replacement: (in mL)
    • 0.0476 x wt (kg) x (normal - observed Hgb) + 1mL/5 kg
  • maximum 14 mL for iron stores
  • # of mg = 0.3 x weight (lbs) (100 - 100 x Hgb/14.8)
• iron replacement for blood loss
  • iron (mg) = blood loss (mL) x hematocrit
  • maximum daily dose:* 100 mg of iron (2 mL)

* thus replacement dose is given over several days with maxumum daily dose of 100 mg of iron (2 mL)

Injection: 50 mg iron/mL for IM or IV administration (2 mL ampule, 5 & 10 mL vial)

Pharmacokinetics

• intramuscular
  • 50-90% of IM dose is rapidly absorbed
  • remainder is absorbed slowly over 1 month
• intravenous
  • iron uptake by reticuloendothelial system is constant
  • eliminated in the urine, feces & by the reticulo- endothelial system
• elimination in urine

Adverse effects

• common (> 10%)
  • staining of skin at site of IM injection, fever/chills, sweating, headache, metallic taste, nausea/vomiting, pain at injection site
• less common (1-10%)
  • discolored urine, diarrhea
• uncommon (< 1%)
  • phlebitis, flushing, arthralgia, respiratory difficulty, lymphadenopathy
• other
  • anaphylactoid reactions
  • cardiovascular collapse
  • hypotension
  • leukocytosis
  • urticaria
  • dizziness
  • adverse reaction may be delayed 3-4 days after IM injection
    • fever, lymphadenopathy, & splenomegaly may occur 4-10 days after IM injection

Mechanism of action

parenteral source of iron

More general terms

• salt
• hematologic agent

Additional terms

• dextran
• Fe+2 (ferrous ion)

Component of

• ascorbate/biotin/calcium carbonate/cobalamin/dextran/folic acid/iron dextran/nicotinic acid/pantothenate/pyridoxine/riboflavin/thiamine