II. Indications

  1. Severe Iron Deficiency Anemia and iron malabsorption
  2. Chronic bleeding not corrected by other means
  3. Oral iron not tolerated
  4. Severe Anemia and refusal of Blood Transfusion

III. Preparations

  1. Iron Dextran (Imferon, Dexferrum)
    1. High rate of serious reaction (requires test dose)
    2. Intramuscular or Intravenous
    3. Dose based on estimated iron deficits
  2. Sodium Ferric Gluconate (Ferrlecit)
    1. Dosing: 125 mg/weekly IV for 8 weeks (total: 1 gram)
    2. Much safer than Iron Dextran (no test dose needed)
  3. Iron sucrose (Venofer)
    1. Much safer than Iron Dextran (no test dose needed)
    2. Dosing: 200 mg IV for 5 doses over 2 week period
  4. Ferumoxytol
    1. Single infusion given over 5 minutes supplies 510 mg elemental iron

IV. Precautions

  1. Intravenous iron must be started very slowly

V. Adverse Effects

  1. Skin staining at site of Intramuscular Injection
    1. Consider Z-tract injection technique
  2. Severe pain at injection site
  3. Fever
  4. Delayed reaction (24-48 hours after administered)
    1. Myalgias and Arthralgias
    2. Headache
  5. Anaphylaxis
    1. Occurs in 0.61% of patients given Iron Dextran
    2. Occurs in 0.04% of patients given ferric gluconate

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Ontology: Iron-Dextran Complex (C0022092)

Definition (NCI) A colloidal solution containing ferric oxyhydroxide complexed with polymerized dextran, used as a form of parenteral iron-replacement therapy. Upon administration and absorption, the iron dextran complex is removed from plasma by the reticuloendothelial system which cleaves it into the components iron and dextran; ferric iron subsequently binds to transferrin or is stored as hemosiderin or ferritin. Transferrin-bound iron is transported in the plasma to the liver, spleen and bone marrow, where is it is incorporated into hemoglobin (Hgb) and to muscle where it is incorporated into myoglobin (Mb). Use of this agent circumvents the gastrointestinal adverse effects commonly encountered with the use of orally administered iron salt preparations. Because of cross-reactivity with antibodies targeted against polysaccharides similar to dextran, anaphylactic reactions may occur with this type of iron formulation.
Definition (MSH) A complex of ferric oxyhydroxide with dextrans of 5000 to 7000 daltons in a viscous solution containing 50 mg/ml of iron. It is supplied as a parenteral preparation and is used as a hematinic. (Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed, p1292)
Concepts Carbohydrate (T118) , Pharmacologic Substance (T121)
MSH D007505
SnomedCT 100874006, 100875007, 21767006, 387118003
English Dextran-Iron Complex, Ferridextran, Dextran Iron Complex, Iron Dextran Complex, IRON DEXTRAN -Retired-, Iron-Dextran Complex, iron dextran, IRON DEXTRAN, Iron-Dextran Complex [Chemical/Ingredient], Iron Dextran, dextran iron, iron dextran complex, IRON DEXTRAN (substance), IRON DEXTRAN COMPLEX (product), Iron dextran, Iron dextran (product), Iron dextran (substance), Iron dextran complex, IRON DEXTRAN COMPLEX (substance), IRON DEXTRAN COMPLEX
Swedish Järn-dextrankomplex
Czech železo-dextranový komplex
Finnish Rauta-dekstraanikompleksi
Russian ZHELEZO-DEKSTRANOVYI KOMPLEKS, DEKSTRAN-ZHELEZO KOMPLEKS, ДЕКСТРАН-ЖЕЛЕЗО КОМПЛЕКС, ЖЕЛЕЗО-ДЕКСТРАНОВЫЙ КОМПЛЕКС
Japanese 鉄-デキストラン錯体, デキストラン-鉄錯体, デキストラン鉄錯塩
Italian Ferridestrano, Complesso ferro-destrano
Spanish hierro dextrano, hierro dextrano (producto), hierro dextrán, hierro dextran (sustancia), hierro dextran (producto), hierro dextran, hierro dextrán (sustancia), IRON DEXTRAN COMPLEX (producto), IRON DEXTRAN COMPLEX, IRON DEXTRAN (sustancia), IRON DEXTRAN - RETIRADO -, IRON DEXTRAN - RETIRADO - (concepto no activo), IRON DEXTRAN COMPLEX (sustancia), hierro dextrano (sustancia), Complejo Dextran-Hierro, Complejo Hierro-Dextran
Polish Kompleks żelazowo-dekstranowy
French Dextriferron
German Dextran-Eisen-Komplex, Eisen-Dextran-Komplex
Portuguese Complexo Dextran-Ferro, Complexo Ferro-Dextran

Ontology: ferumoxytol (C0060274)

Definition (MSH) Iron (II,III) oxide (Fe3O4). It is a black ore of IRON that forms opaque crystals and exerts strong magnetism.
Definition (NCI) A superparamagnetic iron oxide nanoparticle coated with a low molecular weight semi-synthetic carbohydrate, polyglucose sorbitol carboxymethyl ether, with potential anti-anemic and imaging properties. After intravenous administration, ferumoxytol replaces iron stores with fewer side effects compared to the use of oral iron. In addition, this agent generates T1 relaxation, producing a magnetic field and enhancing T2 relaxation, thereby darkening contrast media-containing structures in magnetic resonance imaging (MRI). Due to small particle size, ferumoxytol remains in the intravasculature for a prolonged period and so may be used as a blood pool agent.
Definition (NCI_NCI-GLOSS) A nanoparticle form of iron made in the laboratory that is being studied for use in iron replacement therapy, and as a contrast agent for magnetic resonance imaging. Contrast agents are substances that are injected into the body and taken up by certain tissues, making the tissues easier to see in imaging scans.
Definition (PDQ) A superparamagnetic iron oxide nanoparticle coated with a low molecular weight semi-synthetic carbohydrate, polyglucose sorbitol carboxymethyl ether, with potential anti-anemic and imaging properties. After intravenous administration, ferumoxytol replaces iron stores with fewer side effects compared to the use of oral iron. In addition, this agent generates T1 relaxation, producing a magnetic field and enhancing T2 relaxation, thereby darkening contrast media-containing structures in magnetic resonance imaging (MRI). Due to small particle size, ferumoxytol remains in the intravasculature for a prolonged period and so may be used as a blood pool agent. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=377345&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=377345&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C38138" NCI Thesaurus)
Concepts Indicator, Reagent, or Diagnostic Aid (T130) , Inorganic Chemical (T197)
MSH D052203
SnomedCT 442951001, 442952008, 51922007
Russian ЖЕЛЕЗА (II, III) ОКСИД, ЖЕЛЕЗА (II), (III) ОКСИД, ЖЕЛЕЗА (II)(III) ОКСИД, ZHELEZA (II, III) OKSID, ZHELEZA (II)(III) OKSID, ZHELEZA ZAKIS'-OKIS', ZHELEZA (II), (III) OKSID, МАГНЕТИТ, MAGNETIT, FERUMOKSITOL, ФЕРУМОКСИТОЛ, FE3O4, ЖЕЛЕЗА ЗАКИСЬ-ОКИСЬ
Italian Ossido ferroso ferrico, Ossido ferroso-ferrico
Swedish Magnetit
Czech oxid železnato-železitý, oxid železnatoželezitý
Finnish Rautaoksidi
Japanese 磁鉄鉱, マグネタイト, 四三酸化鉄, 黒色酸化鉄, 磁性酸化鉄, 酸化鉄(III)鉄(II), 酸化第一鉄第二鉄
English Triiron Tetraoxide, Black Iron Oxide, Magnetic Black, Iron Black, FERUMOXYTOL NON-STOICHIOMETRIC MAGNETITE, FERUMOXYTOL, Ferumoxytol (substance), Ferumoxytol (product), ferumoxytol, Ferrosoferric Oxide [Chemical/Ingredient], Ferumoxytol Non-Stoichiometric Magnetite, FERROSOFERRIC OXIDE, ferrosoferric oxide, Ferrosoferric oxide, C.I. 77499, Iron (II, III) Oxide, Ferumoxytol, Black iron oxide, Ferriferrous Oxide, Ferrosoferric Oxide, Oxide, Ferriferrous, Oxide, Ferrosoferric
Spanish ferumoxytol (producto), ferumoxytol (sustancia), ferumoxytol, Óxido Ferrosoférrico, Ferumoxitol, Not Translated[Ferrosoferric Oxide], óxido de hierro negro
French Oxyde de fer noir, Férumoxytol, Oxyde ferrosoferrique
Polish Magnetyd, Ferumoksytol, Farhem
German Ferumoxytol, Ferroferrioxid
Norwegian Magnetitt
Portuguese Ferumoxitol, Óxido Ferroso-Férrico, Not Translated[Ferrosoferric Oxide]

Ontology: Ferrlecit (C0117571)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C035552
English Ferrlecit, ferrlecit

Ontology: Parenteral iron (C0444624)

Concepts Pharmacologic Substance (T121)
SnomedCT 255668001
English Parenteral iron, iron parenteral, parenteral iron, Parenteral form iron (product), Parenteral form iron, Parenteral iron (product), Parenteral iron (substance)
Spanish hierro parenteral, hierro parenteral (producto), hierro, forma farmacéutica parenteral (producto), hierro, forma farmacéutica parenteral

Ontology: Venofer (C0529374)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C101222
English Venofer, venofer

Ontology: Imferon (C0701986)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D007505
English imferon, Imferon, Sanofi Brand of Iron-Dextran Complex

Ontology: Sodium ferric gluconate complex (C0875947)

Definition (NCI_NCI-GLOSS) A form of the mineral iron that is used to treat anemia caused by low amounts of iron in the blood. Anemia is a condition in which the number of red blood cells is below normal. Ferrlecit is a type of hematinic and a dietary supplement.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
SnomedCT 116130008
English FERRIC NA GLUCONATE, sodium ferric gluconate complex, na ferric gluconate, ferric sodium gluconate, SODIUM FERRIC GLUCONATE COMPLEX, sod ferric gluc complex, sodium ferric gluconate, Sodium ferric gluconate complex, Sodium ferric gluconate complex (substance), FERRIC NA GLUCONATE COMPLEX, Sodium Ferric Gluconate Complex
Spanish complejo de gluconato férrico de sodio (sustancia), complejo de gluconato férrico de sodio

Ontology: iron sucrose injection (C1831745)

Definition (NCI) A sterile aqueous complex of polynuclear iron (III)-hydroxide in sucrose for intravenous use. Following intravenous administration, iron sucrose is dissociated by the reticuloendothelial system into iron and sucrose; the sucrose component is eliminated mainly by urinary excretion. Iron sucrose can be administered with or without erythropoietin to raise hemoglobin levels and may be used in cases of oral iron therapy intolerance or ineffectiveness. Hypersensitivity reactions are less common with iron sucrose compared to other parenteral iron products, such as iron dextran.
Definition (PDQ) A sterile aqueous complex of polynuclear iron (III)-hydroxide in sucrose for intravenous use. Following intravenous administration, iron sucrose is dissociated by the reticuloendothelial system into iron and sucrose; the sucrose component is eliminated mainly by urinary excretion. Iron sucrose can be administered with or without erythropoietin to raise hemoglobin levels and may be used in cases of oral iron therapy intolerance or ineffectiveness. Hypersensitivity reactions are less common with iron sucrose compared to other parenteral iron products, such as iron dextran. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=467930&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=467930&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C60883" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
English Iron Sucrose Injection, Iron Sucrose for Injection, iron sucrose injection, Iron Saccharate Injection, Ferric Hydroxide Saccharate Injection, Intravenous Ferric Hydroxide Saccharate