iron dextran

iron dextran,

an injectable hematinic.

indication It is prescribed in the treatment of iron deficiency anemia that is not responsive to oral iron therapy.

contraindications Early pregnancy, anemias other than iron deficiency anemia, or known hypersensitivity to this drug prohibits its use.

adverse effects Among the more serious adverse effects are severe hypersensitivity reactions, including fatal anaphylaxis. Inflammation or phlebitis at the site of injection, arthralgia, headache, GI distress, fever, and lesser hypersensitivity reactions may occur.

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iron

a chemical element, atomic number 26, atomic weight 55.847, symbol Fe. See Table 6. Iron is chiefly important to the animal body because it is the main constituent of hemoglobin, cytochrome, and other components of respiratory enzyme systems. A constant although small intake of iron in food is needed to replace erythrocytes that are destroyed in the body processes.

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iron-59

a radioisotope of iron having a half-life of 45 days; used in ferrokinetics tests to determine the rate at which iron is cleared from the plasma and incorporated in red cells. Symbol ⁵⁹Fe.

iron binding

absorbed iron is rapidly and tightly bound to a specific transport protein, transferrin or siderophilin, from which it is discharged at iron receptor sites in the bone marrow.

iron dextran

an injectable form of iron used in the prevention of iron deficiency. See iron poisoning (below).

iron galactan

used as an injection vehicle for iron in young piglets.

iron nutritional deficiency

is most common in piglets raised on sows kept indoors under artificial conditions. Clinical signs are pallor, dyspnea, edema of the head and a secondary diarrhea.

organic iron poisoning

see iron poisoning (below).

iron overload

storage of excessive iron in body tissues such as occurs in human idiopathic hemochromatosis is not recorded in animals, but overload may occur as a result of excessive therapy.

iron poisoning

overdosing piglets with iron compounds by mouth causes diarrhea and death. Organic iron preparations, usually dextrans, injected in piglets can cause deaths acutely, within an hour or two of injection. At postmortem examination there is myonecrosis of skeletal muscle. Deaths have also occurred within a few minutes of intramuscular injection of organic iron preparations in horses. Sudden death due to massive liver damage also recorded in newborn foals dosed orally with ferrous fumarate with or without yeast in a paste. Asymmetry of the hindquarters in pigs is also recorded as a sequel of intramuscular injections of iron. See also asymmetric hind quarter syndrome. Bore water often contains significant levels of iron and when used for fish culture in dams may cause mortalities.

iron pool

a source of readily available iron for metabolic emergencies, probably located in the bone marrow.

iron storage disease

hemochromatosis.

iron-sulfur proteins

polypeptides that contain iron-sulfur centers capable of Fe₂S₂ or Fe₄S₄ stoichiometry and with standard reduction potential between NAD+ and ubiquinone. Critical components of many electron transport chains, e.g. in oxidative phosphorylation and photosynthesis.

total iron-binding capacity

the serum iron plus the unbound iron-binding capacity of the serum.

iron turnover

see iron turnover.

unbound iron-binding capacity

that portion of the plasma transferrin molecule that is not bound to Fe³+.

iron-yeast paste

highly hepatoxic in some newborn foals when fed as a dietary supplement.

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iron dextran

Cosmofer (UK), DexFerrum, InFeD

Pharmacologic class: Trace element

Therapeutic class: Iron supplement

Pregnancy risk category C

FDA Boxed Warning

• Parenteral use has caused anaphylactic-type 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.

Action

Replenishes depleted stores of iron (a component of hemoglobin) in bone marrow

Availability

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

Contraindications

• Hypersensitivity to drug, alcohol, tartrazine, or sulfites
• Acute phase of infectious renal disease or hemolytic anemia

Precautions

Use cautiously in:
• autoimmune disorders, arthritis, severe hepatic impairment
• elderly patients
• breastfeeding patients
• children.

Administration

• 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.

Route	Onset	Peak	Duration
I.V., I.M.	4 days	1-2 wk	Wks-mos

Adverse reactions

CNS: dizziness, headache, syncope, seizures

CV: chest pain, tachycardia, hypotension

GI: nausea, vomiting

Hematologic: hemochromatosis, hemolysis, hemosiderosis

Musculoskeletal: joint pain, myalgia

Respiratory: dyspnea

Other: abnormal or metallic taste, tooth discoloration, fever, lymphadenopathy, hypersensitivity reactions including anaphylaxis

Interactions

None significant

Patient monitoring

☞ 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.

Patient teaching

• 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.