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Iron Dextran Injection - Uses, Dosage, Side Effects, Drug Warnings, and Precautions

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Iron Dextran injection is a drug used to treat iron-deficiency anemia. Read more about the drug below.

Written by

Krupamol Joy

Medically reviewed by

Dr. Mohammad Rajja

Published At December 2, 2022
Reviewed AtDecember 7, 2022

Overview:

Iron Dextran injection is a medication used as an iron replacement product to treat iron deficiency anemia in adults and children (>4 months) who have an unsatisfactory response to oral iron supplementation. Iron Dextran injection is available as an injection solution for intravenous and intramuscular administration. It is a hematinic that improves the body's iron stores, thereby facilitating the formation of new blood cells. The U.S. Food and Drugs Administration approved this drug combination in 1996 to treat iron deficiency anemia. It is also approved for the treatment of anemia due to blood loss.

How Does Iron Dextran Injection Work?

Through the action of its iron component, which generates Hemosiderin or ferritin and transferrin by binding to protein moieties, iron Dextran replenishes hemoglobin and depletes iron levels.

Uses:

Iron Dextran is used to treat adult and pediatric patients with diagnosed iron insufficiency who are four months of age or older, intolerant to oral iron, or who did not respond well to oral iron.

Dosage:

A healthcare professional only administers Iron Dextran injection in a clinical setting.

  • The infusion may be delayed or discontinued if any side effects occur.

  • Before administering the Iron Dextran injection, stop using any iron-containing products.

  • Identify baseline iron storage and hematologic (hemoglobin and hematocrit) characteristics, binding capacity, and transferrin saturation percentage) to track treatment response.

  • Before administering a therapeutic dose of Iron Dextran injection, a test dose will be provided.

What Are the Drug Warning and Precautions?

Hypersensitivity: After the parenteral injection of iron dextran products, particularly Iron Dextran injection, severe hypersensitivity responses, including anaphylactic-type reactions, some of which have been deadly and life-threatening, have been documented. Such reactions are typically distinguished by the beginning of abrupt respiratory distress and cardiovascular collapse. In addition, iron dextran test doses have been associated with fatal reactions, which also happened when the test dose was tolerated.

Delayed Reactions: A higher prevalence of adverse responses has been linked to large intravenous dosages, such as those utilized with total dose infusions (TDI). One or more of the following symptoms, including backache and muscle pain. Chills, fever, dizziness, nausea, and vomiting, characterize delayed (1 to 2 days) adverse effects. Symptoms often begin 24 to 48 hours after injection and go away in 3 to 4 days.

Iron Overload: Parenteral iron therapy administered in excess can result in excessive iron accumulation and the potential for autoimmune hemosiderosis (overload of iron in organs).

For Patients

What Is Iron Deficiency Anemia (IDA)?

Anemia is when the blood has a lower-than-normal number of red blood cells. Red blood cells are essential because they carry oxygen from the lungs to the rest of the body. Iron is a mineral found in food and is necessary for producing hemoglobin, a substance in red blood cells that carries oxygen. When the body does not have enough iron, it cannot produce enough hemoglobin, and the blood cannot carry enough oxygen to the body tissues. This can cause fatigue and a variety of other symptoms.

Iron deficiency anemia is the most common type of anemia. It occurs when the body does not have enough iron to make hemoglobin. There are many possible causes of iron deficiency anemia, including blood loss. This can occur due to heavy menstrual periods, gastrointestinal bleeding, blood loss from injuries or surgery, and poor absorption of iron, which can be due to conditions such as celiac disease or inflammatory bowel disease, and pregnancy:

The symptoms of iron deficiency anemia can be mild or severe and include fatigue, weakness, pale skin, shortness of breath, chest pain, dizziness, headache, cold hands and feet, and feet, irregular heartbeat.

Learn More About Iron Dextran Injection:

Before Starting Iron Dextran Injection:

When and Why to Take Iron Dextran Injection?

Iron Dextran injection requires medical supervision for its administration. It treats iron deficiency anemia (low blood cells) and anemia due to blood loss.

Things to Inform The Doctor Before Taking Iron Dextran Injection:

  • Have liver conditions like cirrhosis (scarring of liver tissues) or hepatitis (inflammation of the liver).

  • Have a bacterial or viral infection.

  • Have kidney diseases like acute kidney failure.

  • Have a history of drug allergies.

  • Have autoimmune conditions like systemic lupus erythematosus (SLE).

  • It is treated for rheumatoid arthritis (inflammation of the joints).

  • Have a history of severe asthma, allergies, or eczema (skin inflammation).

Starting Iron Dextran Injection:

How Is Iron Dextran Injection Given?

  • Iron Dextran injection is administered after a test dose to assess any hypersensitivity response of the patient towards the drug. After giving the test dose, the patient is observed for at least an hour.

  • A doctor or nurse administers it via injection, infusion, or injection into a muscle; it will be given in a setting where immune allergic reactions can be appropriately and quickly treated.

  • The weight and hemoglobin (blood iron) level determine the dosage. The doctor will determine the dosage. The infusions will be given twice or three times per week.

What Are the Side Effects of Iron Dextran Injection?

The side effects of Iron Dextran injection include,

Allergic Reaction:

Shortness of breath, nettle rash or hives, flushing, rashes, itching, nausea, shivering, and chest pain are all indications of a potentially severe allergic reaction known as Kounis syndrome. If any of these symptoms arise, contact the doctor immediately. Sometimes, more severe allergic reactions could occur within the first few minutes after taking the Iron Dextran injection (affecting less than 1 in 10,000 people).

The indicators include,

  • Rapid development of breathing issues (respiratory difficulty).

  • Significant heart and circulation issues (cardiovascular collapse).

There have also been cases of delayed allergic reactions, which may occur several hours later

or up to four days following the administration. The indicators could include

  • Aches in the muscles or joints.

  • Intermittently high temperatures (fever).

Call the doctor immediately if any of these symptoms are experienced.

Other side effects include,

  • Abdominal discomfort.

  • Vomiting.

  • Hazy vision.

  • Leg pain.

  • Numbness.

  • Mood changes.

  • Seizures.

  • Lightheadedness.

  • Agitation.

  • Weakness.

  • Reduced blood pressure.

Skin swelling may be a symptom of angioedema, a type of severe allergic reaction.

  • Chest discomfort, rapid heartbeat.

  • Tremors, sweating, and diarrhea.

Possible Side Effects When Given Into the Vein (Intravenously):

When injected into a vein, side effects like pain and swelling (inflammation) around the vein may be experienced. Additionally, there have been complaints of vein irritation.

Possible Side Effects When Medication Is Administered Into the Muscle (Intramuscular):

If injected into the muscles, patients may experience side effects, including skin discoloration, bleeding, boil development, tissue damage, and discomfort.

Report all the side effects to the doctor immediately.

Dietary Alterations:

The doctor will inform you of any dietary considerations while on therapy with the medication. Before starting the treatment, it is important to notify the doctor of all the supplements and multivitamin medications the patient has taken.

What Should Be Done if a Dose Is Missed?

Report to the clinic or hospital in case an appointment is missed. The doctor will schedule the consultation at the earliest to continue the therapy.

What Should Be Done to Treat Iron Dextran Overdose?

Overdosing is unlikely as the medication is administered by a trained professional. They will watch the dosage to prevent an iron buildup in the body. However, if it is noticed that too much of the medication is being administered, inform the doctor or nurse immediately.

For Doctors

Indication:

Iron Dextran injection is indicated for treating people with iron deficiency who cannot or cannot receive adequate treatment through oral administration.

Dosing:

In Adult Patients:

Dose in ml (50 mg elemental iron/mL) = 0.0442 (desired Hb - observed Hb) x lean body weight in kg + (0.26 x lean body weight in kg).

Maximum Dose: 2 mL (100 mg elemental iron) per day until the total dose is reached; administered via slow IV infusion or deep IM injection into the buttock.

In Pediatric Patients:

Four Months or Older, Weight More Than 15 kg:

Dose in ml (50 mg elemental iron/ml) = 0.0442 (desired Hb - observed Hb) x lean body weight in kg + (0.26 x lean body weight in kg).

Maximum Dose: 2 mL (100 mg elemental iron) per day until the total dose is reached; administered via slow IV infusion or deep IM injection into the buttock.

Four Months or Older, Weight 5 to 15 kg:

Dose in mL (50 mg elemental iron/mL) = 0.0442 (desired Hb - observed Hb) x weight (kg) + (0.26 x weight in kg).

Maximum Daily Dose: Less than 5 kg, 0.5 mL (25 mg elemental iron); 5 kg up to 10 kg, 1 mL (50 mg elemental iron); more than 10 kg, 2 mL (100 mg elemental iron); administer via slow IV infusion or deep IM injection into buttock.

Mechanism of Action:

Post administration, the circulating Iron Dextran is taken from the plasma by reticuloendothelial system cells, which separate the complex into its iron and dextran constituents. The physiological forms of iron, Hemosiderin or ferritin, or to a lesser extent transferrin, are formed as soon as the iron is bound to the accessible protein moieties. This physiologically controlled iron restores depleted iron reserves and hemoglobin.

Pharmacodynamics:

Iron deficiency anemia results from untreated depletion of iron stores, which also causes iron-deficient erythropoiesis. Changes in serum ferritin levels reflect adjustments to the calculated amounts of cellular non-heme iron. An increase in the reticulocyte count following iron dextran infusion can be used to detect treatment response.

Active and Inactive Ingredients:

In water for injection, one ml equals 50 mg of elemental iron (in the form of an Iron Dextran complex) and around 0.9 % sodium chloride.

Pharmacokinetics:

Iron Dextran injection is absorbed after intramuscular injection within 72 hours, and any remaining iron is absorbed over the following 3 to 4 weeks. The half-life values obtained from various research using intravenously delivered 59Fe iron dextran to iron deficient participants, some of whom also had a concurrent illness, ranging from 5 hours to more than 20 hours.

A study that used laboratory techniques to extract the circulating 59Fe iron dextran from the transferrin bound 59Fe was used to determine the 59Fe iron dextran five-hour value. The half-life of 20 hours was calculated by measuring 59Fe in both its circulating and bound states.

It is important to note that these half-life figures do not indicate iron removal from the body. After receiving an intravenous dosage of Iron Dextran injection, serum ferritin peaks 7 to 9 days later and reverts to baseline after roughly three weeks.

Absorption:

Iron Dextran injection is absorbed from the injection site into the capillaries and the lymphatic system after being administered intramuscularly.

Distribution:

To a lesser extent, Hemosiderin, ferritin, or transferrin are formed when the circulating iron is attached to the available protein moieties.

Metabolism:

Following Iron Dextran injection administration, reticuloendothelial system cells break down circulating iron dextran into its iron and dextran components.

Excretion:

After the delivery of iron dextran, very little iron is lost through the digestive or urinary systems.

Toxicity:

Non-Clinical Toxicity:

Iron-carbohydrate combination intramuscular injection may be linked to a higher risk of carcinogenesis. For example, it has been shown that these complexes may cause sarcoma in mice, rats, rabbits, and possibly hamsters after being repeatedly injected with high or low-iron-carbohydrate complexes at a single injection site. In addition, the literature contains numerous accounts of human patients who had previously had intramuscular injections of iron-carbohydrate complexes and who developed malignancies at the injection site.

Clinical Toxicity:

It is unlikely that taking too much iron dextran will cause immediate signs of iron poisoning. However, adverse effects have been documented after a single dose when used therapeutically, even though they can take up to two days to manifest. In addition, an increased chance of experiencing severe anaphylactoid reactions has been linked to more than 500 mg doses. For example, an adult who received a dose of 32 mL experienced moderate toxicity, yet, a child who received an intravenous dose of 1300 mg over 48 hours showed no symptoms.

Management of Mild to Moderate Toxicity:

Supportive and symptomatic care is provided. Use IV fluids to treat mild hypotension. In contrast to ferrous sulfate, the exposure route may reduce the likelihood of developing iron toxicity. Symptoms may not appear for 24 to 48 hours after iron levels have peaked. Continue achieving the levels specified. Iron dextran is anticipated to behave similarly to other ferrous compounds.

Management of Severe Toxicity:

  1. Use 10 to 20 mL/kg of intravenous 0.9 % NaCl to treat severe hypotension.

  2. If a patient does not respond to fluids, add dopamine or norepinephrine.

  3. Use IV Benzodiazepines to treat seizures; Barbiturates or Propofol may be required if they last or recur.

Anaphylaxis has frequently been described as a side effect of treatment after iron dextran test dosages. Oxygen therapy, Bronchodilators, Diphenhydramine, Corticosteroids, Vasopressors, and Epinephrine, may be necessary for patients experiencing an acute allergic reaction. Watch the breathing and blood pressure. If severe vomiting, diarrhea, acidosis, or hypotension appear as indications or symptoms of iron poisoning, deferoxamine should be administered. Some people may experience hypotension from faster rates or IV boluses.

Warning and Precaution:

Anaphylaxis: Anaphylactic reactions, including fatalities and other hypersensitivity reactions, have been reported; as increased risk in patients with a history of drug allergy, multiple drug allergies, or those using ACE inhibitors. Resuscitation equipment, including epinephrine, should be readily available; administer the test dose, and observe for symptoms of anaphylaxis for at least one hour before administering the therapeutic dose.

Delayed Reactions: One to two days after administering large doses, delayed responses, such as arthralgia, backache, chills, dizziness, fever, headache, malaise, myalgia, nausea, and vomiting, have been documented. Check for symptoms.

Immunologic: Patients with rheumatoid arthritis risk experiencing an acute aggravation of joint pain and swelling.

Cardiovascular: Adverse responses could worsen cardiovascular problems in people with cardiovascular disease.

Hematologic: Patients with hemoglobinopathies and other refractory anemias are at a higher risk of developing exogenous hemosiderosis due to unwarranted treatment.

Hepatic: Use extreme caution in patients with serious hepatic impairment.

Oncologic: Patients with iron-carbohydrate complexes have been observed to develop tumors at the injection site.

Renal: Use caution when infectious kidney disease occurs in its acute phase.

Respiratory: Patients with a substantial history of allergies or asthma should be cautiously treated.

Sepsis: With IM dosing in neonates, there may be an elevated risk of gram-negative sepsis (mainly brought on by Escherichia coli).

What Are the Contraindications of Iron Dextran Injection?

Iron Dextran injection is contraindicated in patients hypersensitive to the active and inactive components of the drug. It is also contraindicated for use in patients whose anemia is not associated with iron deficiency.

Dosage Form:

  • For intravenous or intramuscular use, iron dextran is a dark brown, slightly viscous, sterile liquid combination of dextran and ferric hydroxide.

  • It is available as a 50 mg/ml injection solution.

How to Store Iron Dextran Injection?

  • There are no specific storage requirements for this medication.

  • Avoid freezing.

  • Before use, visually check ampoules for damage and sediment. Use only those that have a homogenous, sediment-free solution.

  • The product will be appropriately stored and disposed of by hospital staff.

  • It should not be used past the ampoule's specified expiration date.

Clinical Studies:

Total-Dose Infusion:

  • According to Auerbach's retrospective study, patients with iron deficiency anemia can safely and effectively receive a total dose of 1000 mg of iron dextran over an hour.

  • Similar results were found by Plummer et al. in teenagers and children older than 11 months.

  • Mamula and associates discovered that a 2000 mg dose administered over two hours was secure and efficient for children and young adults.

Other Specifications:

Iron Dextran injection in Pregnant Women:

Iron dextran has been demonstrated to be embryocidal and teratogenic in mice, rats, rabbits, dogs, and primates when administered in amounts that are roughly three times the maximum human dose. There is no sufficient and reliable research on expectant mothers. Iron Dextran injection should be administered during pregnancy if the potential benefit outweighs the potential risk to the fetus.

Iron Dextran injection in Lactating Women:

Human milk contains minute amounts of unmetabolized iron dextran excretion. Hence, use caution in breastfeeding women.

Iron Dextran injection in Pediatric Patients:

Use is not recommended for infants under the age of four months.

What Are the Drug Interactions of Iron Dextran Injection?

The drug interactions of Iron Dextran injection are as listed below:

With Other Drugs:

  • Baloxavir marboxil.

  • Bictegravir.

  • Dimercaprol.

  • Dolutegravir.

  • Eltrombopag.

  • Elvitegravir.

  • Erdafitinib.

  • Ethinyl Estradiol.

  • Magnesium Sulfate.

  • Raltegravir.

  • Carbidopa.

  • Cefdinir.

  • Ciprofloxacin.

  • Delafloxacin.

  • Demeclocycline.

  • Doxycycline.

  • Gatifloxacin.

  • Grepafloxacin.

  • Levodopa.

  • Levofloxacin.

  • Levothyroxine.

  • Lomefloxacin.

  • Methyldopa.

  • Minocycline.

  • Moxifloxacin.

  • Mycophenolate mofetil.

  • Mycophenolic acid.

  • Norfloxacin.

  • Ofloxacin.

  • Omadacycline.

  • Omeprazole.

  • Penicillamine.

  • Temafloxacin.

  • Tetracycline.

  • Trovafloxacin mesylate.

  • Zinc.

With Alcohol: Iron Dextran injection has no serious interaction with alcohol. Only moderate drinking is preferred.

With Food: There are no severe food-drug interactions for Iron Dextran injection.

Frequently Asked Questions

1.

How Is Iron Dextran Administered?

Iron Dextran is available as a solution and can be administered by injecting into the muscles or intravenously (into a vein). It must be administered only by a healthcare provider. Oral iron therapy must be discontinued before the parental administration of Iron Dextran. A test dose must be administered prior to the first therapeutic dose.

2.

How Does Iron Dextran Work?

Iron Dextran belongs to a class of medications called iron replacement products and is used in the treatment of patients with severe iron deficiency anemia or severe blood loss due to hemophilia, surgeries, gastrointestinal bleeding, etc. It mainly works by replenishing the iron stores in the body, which helps the body produce more red blood cells, and a noticeable response may be observed within three to ten days.

3.

What Are the Side Effects of Iron Dextran?

The side effects of Iron Dextran include:
- Swelling or weakness at the site of injection.
- Numbness or tingling sensation in the arms, hands, legs, and feet.
- Changes in taste perception.
- Sweating.
- Brown discoloration of the skin.
- Muscle or joint pain.
- Intermittent fever.
- If serious side effects such as chest tightness, chest pain, or blood in the urine are observed, a doctor must be contacted immediately.

4.

What Is the Dosage of Iron Dextran?

Initially, a test dose of 25 mg (0.5mL) is administered, followed by monitoring of the patient for one hour. The remainder of the calculated dose required for the patient is then given if no anaphylactoid reactions are observed. Intramuscular injections are administered using the Z-track technique to the upper outer quadrant of the buttock.

5.

How Long Does It Take for Hemoglobin to Rise After Iron Infusion?

Following an intravenous infusion of Iroc Dextran, a rapid replenishment occurs in the iron storage with a peak ferritin concentration at around seven to nine days after infusion. The hemoglobin level may rise within two to three weeks following the infusion.

6.

Are Iron Injections Better Compared to Iron Tablets?

Oral iron tablets are simple, easy to take, and inexpensive for patients. However, it has side effects such as poor compliance, less absorption, and low efficacy. Parenteral iron therapy is indicated in patients who require rapid iron replacement. However, intramuscular iron injections are painful and can stain the skin permanently. Intravenous iron therapy requires clinical supervision but guarantees a quick availability of iron to the bone marrow.

7.

How Can Anemia Be Effectively Managed?

Management of anemia depends on the cause and severity. Iron deficiency anemia can be managed by taking oral supplements and making certain dietary changes. Severe anemia is treated by parenteral administration of Iron Dextran, either intramuscularly or intravenously, after a small test dose.

8.

How Is Iron Dextran Diluted?

Iron Dextran is administered undiluted for slow, intermittent intravenous injection and intramuscular route; however, for total dose intravenous infusion, the calculated dose of Iron Dextran is diluted in 250 to 1000 mL of 0.9 percent sodium chloride, or five percent dextrose injection for dilution may be used. 

9.

What Are the Precautions Required for Iron Infusion?

Infusion of iron Dextran must be cautiously performed. A test dose must be administered prior to the first therapeutic dose. Epinephrine must be immediately administered in case of acute hypersensitivity reactions. Patients must be educated on the potential adverse reactions associated with Iron Dextran infusion. 

10.

When Is Iron Dextran Injection Indicated?

Iron Dextran is indicated for patients with severe iron-deficiency anemia in cases where oral therapy with iron tablets was ineffective or poorly tolerated. It is used in patients who experience severe loss of iron or have iron malabsorption diseases such as inflammatory bowel disease, gastric bypass disorder, Crohn’s disease, Celiac disease, etc). It is also recommended during pregnancy or surgical blood loss. 
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Dr. Mohammad Rajja
Dr. Mohammad Rajja

General Practitioner

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