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

Molecular weight                           :165 000

%Protein binding                           :0

%Excreted unchanged in urine     : <0.2

Volume of distribution (L/kg)       :0.031–0.055

half-life – normal/ESRD (hrs)      :5–20/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50     : Dose as in normal renal function

10 to 20     : Dose as in normal renal function

<10           : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD                :Not dialysed. Dose as in normal renal function

HD                     :Not dialysed. Dose as in normal renal function

HDF/high flux   :Not dialysed. Dose as in normal renal function

CAV/VVHD      :Not dialysed. Dose as in normal renal function

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

10 to 20     : mL sodium chloride or glucose 5%Total dose infusion: add to 500 mL sodium chloride 0.9% or glucose 5%Keep under strict supervision during and for 1 hour after infusion

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

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