iron dextran: clinical use

Prescribing considerations

• Confirm iron deficiency with appropriate laboratory tests and assess its cause.
• Use only where oral iron is unsuitable or ineffective, or rapid store replenishment is clinically required.
• Reassess benefit and risk with drug allergy, severe asthma, eczema, atopy, systemic lupus erythematosus or rheumatoid arthritis.
• Administer only where staff and facilities for immediate anaphylaxis management are available.
• Previous tolerance of parenteral iron does not exclude subsequent hypersensitivity.

Contraindications and cautions

• Hypersensitivity to iron dextran, the product or an excipient.
• Known serious hypersensitivity to another parenteral iron product.
• Anaemia not caused by iron deficiency.
• Iron overload or impaired iron utilisation.
• Decompensated liver cirrhosis or hepatitis.
• Acute or chronic infection.
• Acute renal failure.

Monitoring

• Check haemoglobin and indices of iron status.
• Monitor closely for hypersensitivity during every administration and for at least 30 minutes afterwards.
• Stop administration immediately if hypersensitivity or intolerance develops.
• Iron dextran can interfere with bilirubin and calcium results and temporarily discolour serum samples.
• During pregnancy, monitor fetal wellbeing during intravenous administration.

Clinical pharmacology

The stable iron(III)-hydroxide dextran complex is taken up by the reticuloendothelial system. Iron is released gradually and incorporated into ferritin, haemosiderin or transferrin for storage and erythropoiesis; excess iron is not readily eliminated.

Formulation and product differences

• The product is a dark-brown solution licensed for intravenous infusion, slow intravenous injection or undiluted intramuscular injection.
• Intravenous infusion is preferred because it may reduce hypotensive episodes.
• For infusion, mix only with the sodium chloride or glucose solutions specified in the product information, and not with other medicines.
• Ampoules are single-use and should be inspected for damage, sediment and loss of homogeneity.