Adult: Recommended dose: 100-200 mg 2-3 times weekly. If rapid Fe delivery is required, administer as a total dose infusion up to a total replacement dose equal to 20 mg/kg over 4-6 hours. Dosage is individualised according to Hb level and body weight (refer to detailed dosage table). Alternatively, dosage is calculated based on formula. Total dose (mL) = 0.0442 (desired Hb - observed Hb) x LBW (kg) + (0.26 x LBW (kg)). A test dose of 0.5 mL should be given and observe patient for at least 1 hour for signs for hypersensitivity. Usual daily max: 100 mg. Doses are given via slow IM/IV inj or via IV infusion. Dosage recommendation may vary among countries or individual products (refer to specific product guidelines). Child: Dosage recommendations may vary among countries or individual products (refer to specific product guidelines).
Parenteral Iron replacement for blood loss
Adult: Dosage is calculated based on formula. Total dose (mg) = Body weight (kg) x 0.24 x [desired Hb - observed Hb (g/L)], given via slow IM/IV inj or via IV infusion. Dosage recommendation may vary among countries or individual products (refer to specific product guidelines). Child: Dosage recommendations may vary among countries or individual products (refer to specific product guidelines).
Hepatic Impairment
Severe: Contraindicated.
Reconstitution
Solution for infusion or inj: Dilute with 0.9% NaCl or 5% dextrose inj. Instructions for reconstitution may vary among countries or individual products depending on the intended method and route of administration. Refer to specific product guidelines.
Contraindications
Hypersensitivity. Non-Fe deficiency anaemia (e.g. haemolytic anaemia), Fe overload or impaired Fe utilisation (e.g. haemochromatosis, haemosiderosis); acute or chronic infection. Acute renal failure. Severe hepatic impairment, decompensated liver cirrhosis, hepatitis.
Special Precautions
Patient with CV disease, refractory anaemia and/or haemoglobinopathies; history of allergic disorders (including drug allergies), severe asthma, eczema, or other atopic allergy; immune or inflammatory conditions (e.g. SLE, rheumatoid arthritis). Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Delayed infusion reaction (large doses), carcinogenicity, exogenous haemosiderosis, hypersensitivity reactions leading to Kounis syndrome. Eye disorders: Blurred vision. Gastrointestinal disorders: Nausea, vomiting, abdominal pain. General disorders and administration site conditions: Feeling hot. Musculoskeletal and connective tissue disorders: Cramps. Nervous system disorders: Numbness. Respiratory, thoracic and mediastinal disorders: Dyspnoea. Skin and subcutaneous tissue disorders: Rash, pruritus. Vascular disorders: Flushing. Potentially Fatal: Hypersensitivity reactions (e.g. anaphylaxis).
Confirm iron deficient state through clinical and laboratory evidence prior to initiation of therapy. Monitor haemoglobin, haematocrit, reticulocyte count, serum ferritin and Fe, total Fe binding capacity (TIBC). Monitor for signs and symptoms of hypersensitivity/anaphylactic reactions during test dose, for 1 hour after test dose, and during and after treatment.
Overdosage
Symptoms: Acute Fe overload (haemosiderosis). Management: Symptomatic treatment. Administer Fe chelating agents as necessary.
Drug Interactions
Increased risk of hypersensitivity with ACE inhibitors. May reduce absorption of oral Fe.
Lab Interference
May cause falsely elevated values of serum bilirubin, and falsely decreased values of serum Ca. May interfere with bone marrow Fe store examination, and bone scans.
Action
Description: Mechanism of Action: Iron dextran is a complex that is equal to the physiological form of Fe, ferritin. Upon release from the plasma, it replenishes the depleted iron stores in the bone marrow wherein it will be incorporated into haemoglobin. Onset: Within 3-10 days. Pharmacokinetics: Absorption: Absorbed through the lymphatic system after IM inj. Taken up by the reticuloendothelial cells in the liver and spleen after IV inj. Distribution: Enters breast milk (trace amount). Metabolism: Split by reticuloendothelial system into Fe and dextran. Excretion: Via urine and faeces (small quantities). Elimination half-life: Approx 5 hours (circulating Fe); approx 20 hours (total Fe).
Chemical Structure
Iron dextran Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 105075, Iron dextran. https://pubchem.ncbi.nlm.nih.gov/compound/Iron-dextran. Accessed Sept. 27, 2021.
Storage
Store below 25°C. Do not freeze. Protect from light. Diluted solution: Store between 2-8°C; stable for 24 hours.
Anon. Iron Dextran Complex. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 06/08/2021.Buckingham R (ed). Iron Dextran. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/08/2021.Cosmofer 50 mg/mL Solution for Infusion and Injection (Pharmacosmos A/S). MHRA. https://products.mhra.gov.uk. Accessed 06/08/2021.Cosmofer 50 mg/mL Solution for Infusion and Injection (Solupharm GmbH). MIMS Malaysia. http://www.mims.com/malaysia. Accessed 06/08/2021.Infed Iron Dextran Injection (Allergan, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 06/08/2021.Joint Formulary Committee. Iron Dextran. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/08/2021.
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