Parenteral Iron Therapy: A Single Institution's Experience Over a 5-Year Period

Laman, Christopher A.; Silverstein, Scott; Rodgers, George M.

doi:10.6004/jnccn.2005.0047

Cited by 14 publications

(13 citation statements)

References 7 publications

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“…Physicians frequently premedicate patients with diphenhydramine prior to the administration of LMWD. Premedication with diphenhydramine and acetaminophen prior to iron dextran infusions has been shown to reduce adverse events 46. In a single institution study, the adverse event rate per iron infusion was 4.4% (four events in 91 infusions) with premedication using diphenhydramine and acetaminophen compared with 12.3% (ten events in 81 infusions) without premedication ( P = 0.054) 46.…”

Section: Management Of Iron Deficiency Anemiamentioning

confidence: 99%

Iron deficiency anemia in patients with inflammatory bowel disease

Goldberg

2013

CEG

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Iron deficiency anemia is the most common form of anemia worldwide, caused by poor iron intake, chronic blood loss, or impaired absorption. Patients with inflammatory bowel disease (IBD) are increasingly likely to have iron deficiency anemia, with an estimated prevalence of 36%–76%. Detection of iron deficiency is problematic as outward signs and symptoms are not always present. Iron deficiency can have a significant impact on a patient’s quality of life, necessitating prompt management and treatment. Effective treatment includes identifying and treating the underlying cause and initiating iron replacement therapy with either oral or intravenous iron. Numerous formulations for oral iron are available, with ferrous fumarate, sulfate, and gluconate being the most commonly prescribed. Available intravenous formulations include iron dextran, iron sucrose, ferric gluconate, and ferumoxytol. Low-molecular weight iron dextran and iron sucrose have been shown to be safe, efficacious, and effective in a host of gastrointestinal disorders. Ferumoxytol is the newest US Food and Drug Administration-approved intravenous iron therapy, indicated for iron deficiency anemia in adults with chronic kidney disease. Ferumoxytol is also being investigated in Phase 3 studies for the treatment of iron deficiency anemia in patients without chronic kidney disease, including subgroups with IBD. A review of the efficacy and safety of iron replacement in IBD, therapeutic considerations, and recommendations for the practicing gastroenterologist are presented.

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Section: Management Of Iron Deficiency Anemiamentioning

confidence: 99%

Iron deficiency anemia in patients with inflammatory bowel disease

Goldberg

2013

CEG

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“…One study found that patients who took ACE inhibitors were at highest risk of life-threatening anaphylaxis to iron dextran (either INFeD or Dexferrum) [16], but information on drugs besides the iron preparations and other possible risk factors were not collected in most studies. This is an important omission since studies have found that history of drug allergy and multiple drug allergy were predictors of reactions [17,18] and sensitivity to iron dextran was a predictor of future reactions to other iron products [19,20]. In a multicenter, crossover, randomized doubleblind, placebo-controlled trial of sodium ferric gluconate complex (Ferrlecit), 3 (2.1%) of 143 iron dextran sensitive patients exposed to Ferrlecit had suspected allergic reactions including one patient (0.7%) with a serious reaction [19].…”

Section: Discussionmentioning

confidence: 99%

Use of parenteral iron products and serious anaphylactic‐type reactions

Wysowski¹,

Swartz²,

Borders-Hemphill³

et al. 2010

American J Hematol

100

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Controversy exists about the safety of the parenteral iron dextran products, Dexferrum and INFeD, which have been associated with rare, serious anaphylactic-type reactions. In the United States, their product labels carry boxed warnings of this adverse event; some have called for the withdrawal from marketing of the higher molecular weight Dexferrum. Between 2002 and 2007, sales of Dexferrum, INFeD, and iron gluconate Ferrlecit declined 32.5%, 21%, and 4.8%, respectively, while sales of iron sucrose Venofer increased 160%. Voluntary reports submitted to the Food and Drug Administration show anaphylactic reactions and symptoms for the four parenteral iron products. Because of underreporting, possible differential reporting, absence of iron dextran brand names, and incomplete use (denominator) data, incidence rates and relative risk estimates cannot be calculated. U.S. death certificate data show that for most years from 1979 through 2006, no more than 3 deaths per year were coded to ''adverse events in therapeutic use of iron preparations;'' brand names were not consistently recorded. Emergency department data show small numbers of visits for treatment of allergic reactions with intravenous iron preparations. The data presented herein show that allergic reactions are possible with all four parenteral iron products, and it is difficult to determine which product has the largest risk based on sales data, voluntarily submitted adverse event reports, death certificates, ED visits, and observational studies performed to date. To help differentiate risk among the parenteral iron products, the brand name of the product always should be provided on medical records, death certificates, and adverse drug reaction reports. Am. J.

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“…On the contrary, in a single institution's experience with parenteral iron therapy over a five-year period (December 1999 to March 2005), premedication with acetaminophen and diphenhydramine before intravenous infusion of iron dextran demonstrated a rate of adverse event per infusion of 4.4% (4 events in 91 infusions) [23]. A rate of adverse event per infusion of 12.3% (10 events in 81 infusions) was observed in patients who did not receive premedication before infusion [23]. These data showed that whether or not a patient had received diphenhydramine or acetaminophen before iron dextran infusion affected how the infusion was tolerated, and the researchers proceeded to recommend that patients receiving iron dextran infusions be premedicated with diphenhydramine and acetaminophen [23].…”

Section: Introductionmentioning

confidence: 98%

“…Premedication prior to intravenous iron administration, however, is often given without any data supporting its benefit, as in the Auerbach et al study [22]. On the contrary, in a single institution's experience with parenteral iron therapy over a five-year period (December 1999 to March 2005), premedication with acetaminophen and diphenhydramine before intravenous infusion of iron dextran demonstrated a rate of adverse event per infusion of 4.4% (4 events in 91 infusions) [23]. A rate of adverse event per infusion of 12.3% (10 events in 81 infusions) was observed in patients who did not receive premedication before infusion [23].…”

Section: Introductionmentioning

confidence: 99%

“…A rate of adverse event per infusion of 12.3% (10 events in 81 infusions) was observed in patients who did not receive premedication before infusion [23]. These data showed that whether or not a patient had received diphenhydramine or acetaminophen before iron dextran infusion affected how the infusion was tolerated, and the researchers proceeded to recommend that patients receiving iron dextran infusions be premedicated with diphenhydramine and acetaminophen [23].…”

Section: Introductionmentioning

confidence: 99%

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Premedication protocol for iron infusions in patients with anaphylactic reaction to parenteral iron: A case series

Hudon¹,

Sibulo²,

Brady³

2016

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. This report is a case study involving two female patients, 37-year-old and 31-year-old. Both females presented with severe iron-deficiency anemia while intolerant to oral iron and suffered anaphylactic reactions to parenteral iron. The method of intervention involved a premedication protocol, which was initiated immediately prior to iron sucrose infusion. For Case 1, the protocol included 10 mg IV dexamethasone, one duoneb (ipratropium bromide/ albuterol sulfate), normal saline at 60 cc/hour, and 0.1 mg epinephrine given subcutaneously at the start of iron infusion, with 0.3 mg of epinephrine available at the bedside as needed for allergic reaction. For Case 2, the protocol included 50 mg IV diphenhydramine, 10 mg IV dexamethasone, one duoneb, normal saline at 50 cc/hour, 0.3 mg epinephrine at the bedside in case of reaction. Conclusion: Patient iron levels were within normal limits after treatment, and no adverse events, such as anaphylactic reactions, occurred. With a precisely implemented premedication protocol initiated immediately prior to iron infusion, results of this case study indicate that such patients might be successfully and safely treated with parenteral iron. IJCRI publishes

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Parenteral Iron Therapy: A Single Institution's Experience Over a 5-Year Period

Cited by 14 publications

References 7 publications

Iron deficiency anemia in patients with inflammatory bowel disease

Iron deficiency anemia in patients with inflammatory bowel disease

Use of parenteral iron products and serious anaphylactic‐type reactions

Premedication protocol for iron infusions in patients with anaphylactic reaction to parenteral iron: A case series

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