Ironing out iron infusions – does premedication reduce adverse reactions during iron polymaltose infusion: a single‐centre retrospective review

Abstract

Aim Iron polymaltose infusions are increasingly prescribed in the management of iron deficiency but the efficacy of premedication to prevent complications of infusion remains uncertain. In order to simplify our infusion protocol, we retrospectively reviewed our experience of patients receiving iron polymaltose infusion to assess its safety profile, identify risk factors for adverse reactions and evaluate the efficacy of premedication in preventing adverse reactions. Methods We conducted a retrospective re view of 300 patients who received iron infusions at Alfred Health (including The Alfred, Caulfield Hospital and Sandringham Hospital) between April 2010 and April 2011. Patients were identified via pharmacy dispensing records during the study period regardless of inpatient or day procedure admission status. Data collected from scanned medical records included: gender, body weight, iron dose, compliance to current guideline, units of blood received, serum iron levels, haemoglobin levels, premedications given/charted, duration of infusion, and any adverse effects that occurred. Results From April 2010 to April 2011, 300 patients who received an iron infusion were reviewed. Mean age was 64 years (range: 19–100), with balanced sex distribution (male:female = 148:152). The existing protocol was followed in 90.3% of the patients; however, premedications (cetirizine and hydrocortisone) were given to only 76.25% patients. Only three (1%) patients developed anaphylaxis, but other side effects included headache (1.4%), rash (1%), chest pain (1%) and fever (0.3%). All three patients who developed anaphylaxis had received premedication. Most side effects occurred within 30–60 min of commencing the infusion, with a mean infusion rate of 117 mL/h. Conclusion Iron polymaltose infusions are generally well tolerated and serious adverse reactions are rare. As a result of this audit, we have modified our guidelines to minimise the use of premedications and to rationalise the monitoring of patients receiving iron infusions. Further research to identify specific risk factors for adverse reactions may allow more targeted use of premedications to prevent specific side effects. Reducing the use of premedication and focusing attention to potential side effects during the 60 min after commencement of infusion could improve efficiency, reduce cost and minimise the inconvenience associated with iron infusions.

Retrospective cohort study comparing the adverse reactions and efficacy of intravenous iron polymaltose with ferric carboxymaltose for iron deficiency anemia

“…A substantial finding was the significantly lower incidence of ADRs associated with FCM compared with iron polymaltose, inferring greater patient tolerance of FCM infusions. The incidence of ADRs for iron polymaltose and FCM found in this study were within the ranges of widely varying documented rates across published studies, from less than 3.6% to 31% for iron polymaltose and 1% to 25% for FCM, and with only rare (≤1%) incidences of anaphylaxis …”

“…Whereas the use of prophylactic premedication was not explored in this study, antihistamines, corticosteroids, and even adrenaline have been trialed in the past to prevent hypersensitivity reactions related to iron infusions. However, efficacy of these premedication strategies has not yet been well established and so routine use is not recommended unless significant patient risk factors are present …”

“…However, efficacy of these premedication strategies has not yet been well established and so routine use is not recommended unless significant patient risk factors are present. 9,18,19 T A B L E 2 Adverse reactions among patients after iron polymaltose or carboxymaltose infusion. a It is acknowledged that there were some limitations to the study.…”

Iron polymaltose safety research

“…Dear Editor, My colleagues and I read with great interest the two recent reports on safety of iron polymaltose from the Alfred Hospital team. 1,2 We were surprised by both articles, which aimed to investigate the safety of iron polymaltose; however, they did not mention how the study population of 300 patients was arrived at, or clarify the power calculation used in the research presented to detect adverse reactions. The follow-up article also mentioned the implementation of an even higher concentration of iron polymaltose, 2000 mg in 250 mL of normal saline, which was above the maximum concentration registered with the Therapeutic Goods Administration.…”

“…On 12 October 2016, the Australian Pharmacy Council (APC) ended the National Credentialing Program of Advanced Practice Pharmacists (APPs) due to sustainability issues. 1 The National Australian Pharmacy Students' Association initially recommended that there be one professional body to have the authority to credential APPs, 2 but now recognise that all professional bodies willing to collaborate should provide this credentialing service. A new entity of a maximum of three organisations should be developed, with equal shares and one board position held by each.…”