Intravenous Iron Therapy: A Summary of Treatment Options and Review of Guidelines

Abstract

Iron replacement for iron-deficiency anemia has historically been accomplished with the use of oral iron therapy. Although oral iron is appropriate for most iron-deficiency anemia patients, many patients do not respond to or may be intolerant of oral iron, or may experience bleeding of sufficient magnitude to require higher iron doses than that achievable with oral iron. Intravenous iron therapy is a useful option for these latter patients. Three intravenous iron products are recommended: low-molecular weight iron dextran (INFeD), ferric gluconate (Ferrlecit), and iron sucrose (Venofer). These intravenous iron products have superior safety profiles compared to high-molecular weight iron dextran. The Food and Drug Administration's approval of erythropoietic-stimulating agents to treat certain types of anemia has increased usage of intravenous iron for functional iron deficiency. This review summarizes the current status of intravenous iron products and discusses their advantages and disadvantages in treating both absolute and functional iron deficiency.

Iron deficiency and anaemia in heart failure: understanding the FAIR‐HF trial

“…However, there was no increase in the risk of infection or cardiovascular events in the FAIR‐HF trial 16. Also, in contrast to dextran iron, currently used IV iron preparations, such as ferric saccharate, ferric gluconate, or ferric carboxymaltose are well tolerated and do not require a test dose as they have fewer hypersensitivity reactions 29. The total iron dose required for iron repletion in the FAIR‐HF trial was calculated according to Ganzoni's formula30 and was administered as ferric carboxymaltose in weekly doses of 200 mg as an intravenous bolus injection.…”

“…The total iron dose required for iron repletion in the FAIR‐HF trial was calculated according to Ganzoni's formula30 and was administered as ferric carboxymaltose in weekly doses of 200 mg as an intravenous bolus injection. This is an advantage over the administration of 200 mg of ferric saccharate, which is normally given over a period of 1–2 h, as higher doses can cause hypotension 29. After this correction phase, a maintenance phase was started, in which 200 mg of iron was given monthly until Week 24.…”

Direct Comparison of the Safety and Efficacy of Ferric Carboxymaltose versus Iron Dextran in Patients with Iron Deficiency Anemia

“…The incidence of side effects increase with the dose and adversely affects compliance. Also, oral iron is often not capable of replenishing severe iron deficits [9]. As a treatment of last resort, blood transfusions are used, but they may lead to the transmission of known and unknown pathogens, immunological impact, and transfusion reactions.…”

Study of intravenous ferric carboxy maltose in iron deficiency anemia in women attending gynecological clinic - safety and efficacy

“…Oral iron preparations are also not appropriate for treatment of severe iron deficiency anemia (IDA) where rapid replenishment of iron stores is required. 2 Various intravenous iron preparations are available for the treatment of IDA. Iron dextran is associated with a potential risk of serious anaphylactic reactions while others need to be given in multiple infusions to avoid labile iron reactions.…”