iron dextran 5%
CLINICAL USE
Prophylaxis of iron deficiency anaemia (when oral treatment is ineffective or contraindicated) Treatment of iron deficiency during epoetin therapy especially if serum ferritin is very low (<50 nanograms/mL)
DOSE IN NORMAL RENAL FUNCTION
Total iron infusion: Dose of iron dextran (mg) = weight (kg) × [Target Hb (g/L) – Actual Hb (g/L)] × 0.24 + 500 mg iron for iron stores (if body weight >35 kg) 20 mg/kg in a single doseTarget haemoglobin level (110 g/L for renal patients as a guide)or100–200 mg 2 or 3 times a week depending on haemoglobinA test dose is essential. Give 0.5 mL or 25 mg iron over 15 minutes and observe for 60 minutes (15 minutes if using low dose bolus) for anaphylaxis. Have resuscitative equipment and drugs at hand (adrenaline, chlorphenamine and hydrocortisone)
PHARMACOKINETICS
DOSE IN RENAL IMPAIRMENT
GFR (mL/MIN)
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsDimercaprol: avoid concomitant use Oral iron: reduced absorption of oral iron
ADMINISTRATION
Reconstition
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Route
IV, IM
Rate of Administration
Infusion: 100 mL over 30 minutes Bolus: 10 mg/minute Total dose infusion: over 4–6 hours; increase rate of infusion to 45–60 drops per minute
Comments
Infusion: 100–200 mg in 100 mL sodium chloride or glucose 5%Bolus: add to
OTHER INFORMATION
Do not give to patients with history of asthmaIf patients with a history of allergy are prescribed iron dextran, give adequate antihistamine cover prior to administrationThe dose of iron dextran varies widely from 100 mg per dialysis session for 6–10 sessions, to single doses of 500 mg to 1 gThe incidence of anaphylaxis with the Cosmofer brand of iron dextran is significantly lower than with the old Imferon brand, since the iron is complexed to a much shorter dextran chain than was used previously