Parenteral iron therapy options

Abstract

Parenteral iron therapy is occasionally necessary for patients intolerant or unresponsive to oral iron therapy, for receiving recombinant erythropoietin therapy, or for use in treating functional iron deficiency. There are now three parenteral iron products available: iron dextran, ferric gluconate, and iron sucrose. We summarize the advantages and disadvantages of each product, including risk of anaphylaxis and hypersensitivity, dosage regimens, and costs. The increased availability of multiple parenteral iron preparations should decrease the need to use red cell transfusions in patients with iron-deficiency anemia.

From Bloodless Surgery to Patient Blood Management

“…34,35 Intravenous iron preparations are available with various formulations (ie, iron dextran, iron sucrose, iron gluconate, and recently approved ferumoxytol), each with specific characteristics to treat iron-deficiency anemia. 36 Given the concerns associated with ESAs, the role of intravenous iron has become even more important as the primary therapy for anemia, and as an adjuvant to ESA therapy, to improve efficiency and decrease the ESA dose. Additionally, evidence indicates that intravenous iron with or without ESA therapy can reduce blood transfusions in surgical patients.…”

Use of parenteral iron products and serious anaphylactic‐type reactions

“…A stated advantage of iron dextran, besides lower cost, is the ability to infuse a patient's total iron requirement in one administration (total dose infusion) [28][29][30] so clinicians can conveniently treat patients in a single hospital or clinic visit. However, the total dose infusion of iron dextran, although widely used, is an off-label method of administration [30] and it is not known if studies with adequately large sample sizes have been done to determine its relative safety.…”

Safety Issues With Intravenous Iron Products in the Management of Anemia in Chronic Kidney Disease

“…98 A number of studies document that anaphylaxis, the serious adverse event associated with iron dextran, is largely due to the two high molecular weight products, Imferon, which is no longer available, and Dexferrum, which is not recommended. 40,42,48,49,53,[99][100][101][102][103][104][105][106] Iron sucrose has the least reported adverse events and high molecular weight iron dextran has the highest number of reported adverse events. Low molecular weight iron dextran and ferric gluconate fall in between these two for the number of adverse drug events.…”