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iron dextran (INFeD, Imferon, Dexferrum)

Tradenames: Imferon, Infed, Dexferrum. Indications: - treatment of iron deficiency when oral treatment is not feasible or ineffective Contraindications: pregnancy category: - safety in lactation: ? Dosage: 1) a test dose of 0.5 mL should be given prior to standard therapy (0.25 mL infants) 2) diphenhydramine & epinephrine should be immediately available 3) a Z-track method should be used for IM injection 4) IM administration is painful & should be given in a large muscle such as the gluteus maximus 5) iron-deficiency anemia a) infusion over 4 hours: b) maximum daily dose:* 100 mg of iron (2 mL) c) total replacement: (in mL) -> 0.0476 x wt (kg) x (normal - observed Hgb) + 1mL/5 kg d) maximum 14 mL for iron stores e) # of mg = 0.3 x weight (lbs) (100 - 100 x Hgb/14.8) [4] 6) iron replacement for blood loss a) iron (mg) = blood loss (mL) x hematocrit b) maximum daily dose:* 100 mg of iron (2 mL) * thus replacement dose is given over several days with maxumum daily dose of 100 mg of iron (2 mL) Injection: 50 mg iron/mL for IM or IV administration (2 mL ampule, 5 & 10 mL vial) Pharmacokinetics: 1) intramuscular a) 50-90% of IM dose is rapidly absorbed b) remainder is absorbed slowly over 1 month 2) intravenous a) iron uptake by reticuloendothelial system is constant b) eliminated in the urine, feces & by the reticulo- endothelial system 3) elimination in urine Adverse effects: 1) common (> 10%) - staining of skin at site of IM injection, fever/chills, sweating, headache, metallic taste, nausea/vomiting, pain at injection site 2) less common (1-10%) - discolored urine, diarrhea 3) uncommon (< 1%) - phlebitis, flushing, arthralgia, respiratory difficulty, lymphadenopathy 4) other - anaphylactoid reactions [5] - cardiovascular collapse - hypotension - leukocytosis - urticaria - dizziness - adverse reaction may be delayed 3-4 days after IM injection - fever, lymphadenopathy, & splenomegaly may occur 4-10 days after IM injection Mechanism of action: parenteral source of iron

Related

dextran Fe+2 (ferrous ion)

General

salt hematologic agent

References

  1. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 576
  3. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  4. Geriatric Dosage Handbook, 6th edition, Selma et al eds, Lexi-Comp, Cleveland, 2001
  5. FDA MedWatch Dexferrum (iron dextran injection) - Labeling Change, 10/16/2009 http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm186899.htm

Component-of

ascorbate/biotin/calcium carbonate/cobalamin/dextran/folic acid/iron dextran/nicotinic acid/pantothenate/pyridoxine/riboflavin/thiamine