Intravenous iron dextran therapy in patients with iron deficiency and normal renal function who failed to respond to or did not tolerate oral iron supplementation

Barton, James C.; Barton, Ellen H; Bertoli, Luigi F.; Gothard, Charlene H; Sherrer, Jennifer S

doi:10.1016/s0002-9343(00)00396-x

Cited by 83 publications

(86 citation statements)

References 15 publications

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“…Premedication with antihistamines is frequently administered without any evidence to support its use. In fact, there are published data indicating that the majority of reactions observed when diphenhydramine is used are due to the premedication and mistakenly attributed to the iron [52]. Barton et al reported that the most commonly observed adverse event with IV iron following diphenhydramine was somnolence due to the premedication.…”

Section: Administration Of Parenteral Iron In Practicementioning

confidence: 99%

How we diagnose and treat iron deficiency anemia

2015

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It is estimated that one‐third of the world's population is anemic, the majority being due to iron deficiency (ID). In adults, ID is associated with fatigue in the absence of anemia, restless legs syndrome, pica and, in neonates, delayed growth and development. In adolescents, ID is associated with decrements in learning and behavioral abnormalities. In the absence of a clear cause, search for a source of bleeding is indicated. No single test is diagnostic of ID unless the serum ferritin is low or the percent transferrin saturation is low with an elevated total iron binding capacity. Oral iron is considered front line therapy except for conditions such as gastric bypass, heavy uterine bleeding, inflammatory bowel disease, and hereditary hemorrhagic telangiectasia. Oral iron has many unpleasant side effects, resulting in low patient adherence. For patients intolerant of, or unresponsive to, oral iron, intravenous (IV) administration is the preferred route. While early formulations were associated with a high incidence of serious adverse events (SAEs), newer formulations are much safer with SAEs occurring very infrequently. Full replacement doses can be administered in a matter of minutes to a few hours. Nevertheless, there remains a reluctance to use IV iron due to a misunderstanding of the safety of the available formulations. IV iron is safe and effective in all clinical circumstances including pregnancy. The preponderance of published evidence suggests IV iron therapy is underutilized and we believe that IV iron should be moved forward in the treatment of ID and iron deficiency anemia (IDA). Am. J. Hematol. 91:31–38, 2016. © 2015 Wiley Periodicals, Inc.

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Section: Administration Of Parenteral Iron In Practicementioning

confidence: 99%

How we diagnose and treat iron deficiency anemia

2015

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“…In patients at higher risk for AEs, pretreatment with corticosteroids may be beneficial. 29 In a review of LMW ID therapy in patients with iron deficiency and normal renal function who were intolerant of oral iron, Barton et al 3 suggested that pretreatment with antihistamines was responsible for the majority of perceived reactions to iron dextran. Because there is no published evidence that antihistamines are beneficial in decreasing acute hypersensitivity reactions to IV iron, it is recommended that pretreatment not be routinely given.…”

Section: Administration and Pharmacologymentioning

confidence: 99%

“…1 It was not until the 19 th century when Pierre Blaud 2 introduced ferrous sulfate and reported cures of chlorosis that oral iron therapy became standard care for what is now recognized as iron deficiency anemia (IDA). Oral iron is a less than ideal treatment, however, with gastrointestinal toxicity occurring in Ͼ 35% to 59% of patients, 3,4 and a long course needed to resolve anemia and replenish stores. Nonadherence to a prescribed course of oral iron is common, and even in adherent patients, poor intestinal absorption fails to compensate for iron need in the presence of ongoing blood losses.…”

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confidence: 99%

Clinical Use of Intravenous Iron: Administration, Efficacy, and Safety

2010

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This section reviews the history, pharmacology, administration, efficacy, and toxicity of intravenous iron. Intravenous iron offers advantages over oral iron for the treatment of iron deficiency anemia across a wide range of disease states associated with absolute and functional iron deficiency. However, there remain concerns about the acute safety profiles of the available preparations and the potential for long-term toxicity with their repeated administration. Seven intravenous iron formulations are available. Confusion concerning the relative toxicities of the different formulations abounds. The similarities and differences are discussed. Iron repletion has been associated with adverse outcomes in infections. The relationship, if any, between intravenous iron administration and infections is reviewed. The potential advantages of total dose infusion (TDI), complete repletion in a single setting, are highlighted. A new paradigm for iron replacement therapy in iron deficiency anemia is presented.

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“…Indeed many of the reactions seen with iron infusions may be actually side effects of therapies given for or to prevent "anaphylaxis." One prospective study reported that the majority of reactions ostensibly attributed to intravenous iron were actually due to premedication with diphenhydramine [11].…”

mentioning

confidence: 99%

“…This knowledge has led to a protocol that treats iron reactions for the infusion reactions they are instead wrongly treated as allergic reactions (Table II) [9,11,12]. This includes treating mild reactions (flushing, itching) with holding the infusion for 15 min and if the patient improves resuming the infusion at a reduced rate diphenhydramine is to be avoided.…”

mentioning

confidence: 99%

Is low‐molecular weight iron dextran really the most risky iron?—Unconvincing data from an unconvincing study

DeLoughery

Auerbach

2016

American J Hematol

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The use of intravenous iron has expanded over the past few years as accepted indications for its use have increased. It is now recognized that intravenous iron will raise iron stores faster and more reliably in conditions in which oral iron is unlikely to work or poorly tolerated such as chronic kidney disease, inflammatory bowel disease, heavy uterine bleeding, hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu), pregnancy, and those having undergone bariatric surgery. However, the acceptance of this effective therapy by physicians has been hindered by concerns about safety of iron infusions. The use of early formulations, such as ferric hydroxide, was associated with high levels of labile free iron release and an unacceptably high incidence of serious hemodynamically significant infusion reactions. By the early 1950s, products with carbohydrate cores which bound the elemental iron more tightly, such as high-molecular weight iron dextran-ImFeron, (Fisons, Homes Chapel, England) and later DexFerrum, (American Regent, Shirley, New York)-which are no longer available, and iron sucrose, were much better tolerated but still associated with rare anaphylactic reactions. Newer formulations which release labile free iron much more slowly, such as low-molecular weight iron dextran (INFeD, Pfizer, New York, NY), ferumoxytol (Feraheme, AMAG, Waltham, MA), ferric carboxymaltose (InjectoFer, American Regent, Shirley, NY), and iron isomaltoside (Monofer, Europe only, Pharmacosmos, Haelbeck, Denmark) are much better tolerated and provide the added convenience of being able to be administered safely in complete replacement doses over 15-60 min.While there are many factors to consider in the choice of iron products-expense, numbers of infusions, effectiveness-safety is also a key factor. One iron product did stand out in risk-high-molecular weight iron dextran (DexFerrum) which has been shown in several studies to have reaction rates higher than other iron products [1][2][3]. This formulation was removed from market in 2009. The accumulated data show that lowmolecular weight iron dextran does not share this higher risk. Studies ranging from dialysis database reviews to a European Medical Agency review have shown no difference in risk with low-molecular weight iron dextran versus other iron products [3][4][5].Recently, this notion of equivalent risk was challenged by a study from the FDA which purported to show a significantly higher rate of "anaphylaxis" with iron dextran compared to other iron products [6]. This study examined 688,183 non-dialysis new users of intravenous iron over 10 years in the outpatient Medicare claims database. The anaphylaxis rate for iron dextran was compared to iron gluconate, iron sucrose, and ferumoxytol. The key finding was that the rate of anaphylaxis for iron dextran had an odds ratio 2.6 times higher reaction rate than all nondextran irons-68 vs. 23 per 100,000 persons.However, there are several issues with this study that cast doubt on the conclusion that low-molecular weight iron dextra...

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Intravenous iron dextran therapy in patients with iron deficiency and normal renal function who failed to respond to or did not tolerate oral iron supplementation

Cited by 83 publications

References 15 publications

How we diagnose and treat iron deficiency anemia

How we diagnose and treat iron deficiency anemia

Clinical Use of Intravenous Iron: Administration, Efficacy, and Safety

Is low‐molecular weight iron dextran really the most risky iron?—Unconvincing data from an unconvincing study

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