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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 B
Replenishes depleted stores of iron (a component of hemoglobin) in bone marrow
Aqueous complex for injection: 20 mg elemental iron/ml in 5-ml single-use vials (100 mg of elemental iron)
Indications and dosages
➣ Iron-deficiency anemia in hemodialysis patients concurrently receiving erythropoietin
Adults: 100 mg of elemental iron (5 ml) I.V. directly into dialysis line or by slow injection or infusion during dialysis session (up to three times weekly) for 10 doses (total of 1,000 mg)
• Autologous blood donation
• Bloodless surgery
• Hypersensitivity to drug, alcohol, tartrazine, or sulfites
• Hemolytic anemias and other anemias not caused by iron deficiency
• Primary hemochromatosis
Use cautiously in:
• autoimmune disorders, arthritis, severe hepatic impairment
• elderly patients
• breastfeeding patients
• Give test dose only if ordered: 50 mg (2.5 ml) I.V. over 3 to 10 minutes.
• Dilute 100 mg of elemental iron in no more than 100 ml of normal saline solution; infuse slowly I.V. over at least 15 minutes.
• Administer I.V. directly into dialysis line or by infusion at 20 mg/minute, not to exceed 100 mg/injection.
• 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: muscle cramps, aches, or weakness; joint pain
Other: abnormal or metallic taste, tooth discoloration, fever, lymphadenopathy, allergic reactions including anaphylaxis
☞ Monitor for hypersensitivity reaction. Keep epinephrine and other emergency supplies available in case reaction occurs.
• Assess hemoglobin, hematocrit, serum ferritin, and transferrin saturation levels before, during, and after therapy.
☞ Monitor blood pressure. Stay alert for hypotension.
• Watch for signs and symptoms of iron overload, such as decreased activity, sedation, and GI or respiratory tract bleeding.
• Caution patient not to take oral iron preparations or vitamin supplements containing iron during therapy.
• Instruct patient to report dyspnea, 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.
iron sucrose(eye-ern su-krose) ,
Pharmacologic: iron supplements
Time/action profile (effects on erythropoesis )
Adverse Reactions/Side Effects
Central nervous system
- headache (most frequent)
- chest pain
- diarrhea (most frequent)
- nausea (most frequent)
- vomiting (most frequent)
- abdominal pain
- ↑ liver enzymes
- taste perversion
Fluid and Electrolyte
- injection site reactions
- leg cramps (most frequent)
- musculoskeletal pain
- hypersensitivity reactions including ANAPHYLACTIC SHOCK (life-threatening)
Drug-Drug interactionChloramphenicol and vitamin E may ↓ hematologic response to iron therapy.
- Monitor BP during infusion. May cause hypotension; usually related to rate of administration and total dose administered.
- Assess for hypersensitivity reactions and anaphylaxis (rash, dyspnea, loss of consciousness, hypotension, collapse, convulsions) for at least 30 min following injection. Equipment for resuscitation should be readily available.
- Lab Test Considerations: Monitor hemoglobin, hematocrit, serum ferritin, and transferritin saturation prior to and periodically during therapy. Transferrin saturation values ↑ rapidly after IV administration; therefore, serum iron values may be reliably obtained 48 hr after IV administration. Withhold iron therapy if evidence of iron overload occurs.
Symptoms of iron overdose or too rapid infusion are hypotension, headache, vomiting, nausea, dizziness, joint aches, paresthesia, abdominal and muscle pain, edema, and cardiovascular collapse. Treatment includes IV fluids, corticosteroids, and/or antihistamines. Administering at a slower rate usually relieves symptoms.
- May cause ↑ liver enzymes.
Potential Nursing DiagnosesActivity intolerance (Indications)
- Do not administer iron sucrose concurrently with oral iron, as the absorption of oral iron is reduced. Each 5 mL vial contains 100 mg of elemental iron.
- Test dose of 50 mg may be used.
- Solution is brown. Inspect for particulate matter or discoloration. Do not administer solutions that contain particulate matter or are discolored.
- Pediatric: Exercise caution when administering and calculating doses; overdosage can be fatal.
- pH: 10.5–11.1. Hemodialysis Dependent Patients:
- Most patients require a minimum cumulative dose of 1000 mg of elemental iron, administered over 10 sequential dialysis sessions, to achieve a favorable hemoglobin or hematocrit response.
- May be administered undiluted by slow injection into dialysis line.
- Rate: Administer undiluted solution at a rate of 100 mg over 2–5 min, not to exceed one vial per injection. Discard any unused portion. Peritoneal Dialysis Patients
- Intermittent Infusion: For Peritoneal Dialysis Patients-Diluent: Dilute each dose in a maximum of 250 mL of 0.9% NaCl.
- Rate: Administer doses of 300 mg over 1.5 hrs and doses of 400 mg over 2.5 hrs.
- Intermittent Infusion: May also be administered via infusion, into dialysis line for hemodialysis patients. May reduce risk of hypotensive episodes. Each vial must be diluted in a maximum of 100 mL of 0.9% NaCl immediately prior to infusion. Discard unused diluted solution.
- Rate: Infuse at a rate of 100 mg of iron over at least 15 min. Non-dialysis Dependent Patients:
- May be administered as a slow injection of 200 mg undiluted.
- Rate: Administer over 2–5 min.
- Intermittent Infusion: Dilute 500 mg in 250 mL 0.9% NaCl.
- Rate: Infuse over 3.5–4 hr on days 1 and 14. May cause hypotension; monitor closely.
- Additive Incompatibility: Iron sucrose should not be admixed with any other medications or parenteral nutrition solutions.
- Explain purpose of iron therapy to patient.
- Instruct patient to report symptoms of hypersensitivity reaction to health care professional immediately.
- Improvement in anemia of chronic renal failure.