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Iron preparations, such as ferrous sulfate, may be necessary in the treatment of iron deficiency anemia; they should be administered after meals, never on an empty stomach. The patient should be warned that the drugs cause stools to turn dark green or black. Overdosage may cause severe systemic reactions.
An acute iron deficiency may warrant parenteral administration of an iron supplement. Hypersensitivity to iron supplements often occurs in patients with other known allergies. In other patients the parenteral administration of iron can cause vomiting, chills, fever, headache, joint pain, and urticaria.
Pharmacologic class: Trace element
Therapeutic class: Iron supplement
Pregnancy risk category C
FDA Box Warning
• Parenteral use has caused anaphylactictype reactions, some resulting in death. Use only in patients with clearly established indications when laboratory tests confirm iron deficiency not amenable to oral iron therapy. Give drug only where resuscitation techniques and treatment of anaphylactic and anaphylactoid shock are readily available.
Replenishes depleted stores of iron (a component of hemoglobin) in bone marrow
Injection: 50 mg/ml
Indications and dosages
➣ Iron-deficiency anemia in patients who can't tolerate oral iron
Adults and children weighing more than 15 kg (33 lb): Dosage individualized based on patient's weight and hemoglobin (Hgb) value, using the following formula: Dosage (ml) = 0.0442 (desired Hgb minus patient's Hgb) times lean body weight (LBW) plus the product of 0.26 times LBW
Give test dose before starting I.V. or I.M. therapy: For I.V. use, administer test dose of 0.5 ml (25 mg) I.V. over 30 seconds to 5 minutes; if no reactions occur within 1 hour, give remainder of therapeutic dose I.V.; repeat this dose daily. For I.M. use, give test dose of 0.5 ml (25 mg) by Z-track method; if no reactions occur, give daily doses not exceeding 100 mg I.M. in adults, 50 mg I.M. in children weighing more than 10 kg (22 lb), or 25 mg in infants weighing less than 5 kg (11 lb).
➣ Iron replacement caused by blood loss
Adults: Dosage individualized based on the following formula: Replacement iron (in mg) = blood loss (in ml) times hematocrit
• Hypersensitivity to drug, alcohol, tartrazine, or sulfites
• Acute phase of infectious renal disease or hemolytic anemia
Use cautiously in:
• autoimmune disorders, arthritis, severe hepatic impairment
• elderly patients
• breastfeeding patients
• For I.M. administration, inject by Z-track method into upper outer quadrant of gluteal muscle.
• For intermittent I.V. infusion, administer undiluted at a rate no faster than 1 ml/minute.
• Don't give with oral iron preparations.
CNS: dizziness, headache, syncope, seizures
CV: chest pain, tachycardia, hypotension
GI: nausea, vomiting
Hematologic: hemochromatosis, hemolysis, hemosiderosis
Musculoskeletal: joint pain, myalgia
Other: abnormal or metallic taste, tooth discoloration, fever, lymphadenopathy, hypersensitivity reactions including anaphylaxis
☞ Monitor for hypersensitivity reaction. Keep epinephrine and other emergency supplies on hand in case reaction occurs.
• Assess serum ferritin levels regularly, because these levels correlate with iron stores.
• In patients with rheumatoid arthritis, monitor for acute exacerbation of joint pain and swelling. Provide appropriate comfort measures.
• Watch for signs and symptoms of iron overload, including decreased activity, sedation, and GI or respiratory tract bleeding.
• Caution patient not to take oral iron preparations or vitamins containing iron during therapy.
• Instruct patient to report difficulty breathing, itching, or rash.
• Tell patient he'll undergo periodic blood testing to monitor his response to therapy.
• As appropriate, review all other significant and life-threatening adverse reactions mentioned above.