Iron Dextran; Uses, Dosage, Side Effects, Interactions

Iron dextran is a form of the mineral iron. Iron is important for many functions in the body, especially for the transport of oxygen in the blood. Iron dextran is used to treat iron deficiencies and iron deficiency anemia? (low red blood cells). It is is a dark brown, slightly viscous liquid complex of ferric hydroxide and dextran for intravenous or intramuscular use. Iron Dextran is used for the treatment of patients with documented iron deficiency in which oral administration is unsatisfactory or impossible.

Mechanism of Action of Iron Dextran

Normal erythropoiesis is dependent on the concentration of iron and erythropoietin available in the plasma. Administration of iron does not stimulate the production of red blood cells, nor does it correct abnormalities not caused by iron deficiency. A therapeutic? response to treatment with iron products is dependent on the patient’s ability to absorb and use the iron, and it is influenced by the cause of the deficiency as well as other illnesses that can affect normal erythropoiesis. After iron dextran is injected, the circulating iron dextran is removed from the plasma by cells of the reticuloendothelial system, which split the complex into its components of iron and dextran. The iron is immediately bound to the available protein moieties to form hemosiderin or ferritin, the physiological forms of iron, or to a lesser extent to transferrin. There is some concern that intravenously administered iron is not used appropriately by the body. Both animal and human data indicate that the bulk of intravenous iron is sequestered in the reticuloendothelial system (i.e., liver?, spleen?), and little is available to the iron-deficient bone marrow?.

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The toxicity of iron in biological systems is believed to be attributed to its ability to catalyze the generation of oxygen-free radicals. In the current investigation, the dose-dependent effects of chronic? iron-loading on heart tissue concentrations of iron, glutathione peroxidase (GPx) activity, free-radical production, and cardiac dysfunction were investigated in a murine model of iron-overload cardiomyopathy?. It was shown that chronic iron-overload results in dose-dependent (a) increases in myocardial iron burden, (b) decreases in the protective antioxidant enzyme GPx activity, (c) increased free-radical production, and (d) increased mortality. These findings show that the mechanism of iron-induced heart dysfunction involves in part free radical-mediated processes.

Indications of Iron Dextran

• Anemia Associated with Chronic Renal Failure?
• Iron Deficiency Anemia
• Iron deficiency due to aging or major surgery
• Pregnancy & Lactation
• Adult men, Adolescent males, and Postmenopausal women
• Adolescent menstruating, premenopausal women
• To restore hemoglobin? and replenish iron stores in iron-deficiency anemia due to causes other than blood loss.
• Iron is an important part of your red blood cells and is needed to transport oxygen in the body. Many patients with kidney? disease cannot get enough iron from food and require injections.
• It is used to replenish body iron stores in Non-Dialysis Dependent-Chronic Kidney Disease? (NDD-CKD?) patients receiving or not receiving erythropoietin and in Hemodialysis Dependent (HDD-CKD) and Peritoneal Dialysis Dependent (PDD-CKD) – Chronic Kidney Disease patients receiving an erythropoietin.
• For treatment of patients with documented iron deficiency in whom oral administration is unsatisfactory or impossible. Also used to replenish body iron stores in Non-Dialysis Dependent-Chronic Kidney Disease (NDD-CKD) patients receiving or not receiving erythropoietin and in Hemodialysis Dependent (HDD-CKD) and Peritoneal Dialysis Dependent (PDD-CKD) – Chronic Kidney Disease patients receiving an erythropoietin.

Contra-Indications of Iron Dextran

• Iron Metabolism Disorder causing Increased Iron Storage
• Increased Bodily Iron from High Red Blood Cell Destruction
• Hemolytic Anemia
• Asthma
• Severe? Liver Disease
• Bacterial Infection? of the Kidney and Renal Pelvis?
• Systemic Lupus Erythematosus?
• Rheumatoid Arthritis
• Rheumatic Disease causing Pain & Stiffness in Backbone
• Too Much Iron in the Blood for a Long Period of Time
• Allergies to Iron Complex, Iron Analogues

The Dosage? of Iron Dextran

Iron Deficiency Anemia

• Administer doses of 2 mL or less, IV, once a day, until the calculated total amount required has been reached
• Dose (mL) = 0.0442 (Desired hemoglobin – Observed hemoglobin) x lean body weight in kg + (0.26 x lean body weight)
• Males: Lean Body Weight = 50 kg + 2.3 kg per inch in height over 60 inches
• Females: Lean Body Weight = 45.5 kg + 2.3 kg per inch in height over 60 inches
• Factors contributing to the formula are shown below.

1. Blood volume . . . . . . . . . . . . . . . .65 mL/kg of body weight
2. Normal hemoglobin (males and females)
   over 15 kg (33 lbs) . . . . . . . . . . . .14.8 g/dl
   15 kg (33 lbs) or less . . . . . . . . . .12.0 g/dl
3. The iron content of hemoglobin . . . . . 0.34%
4. Hemoglobin deficit
5. Weight

Side Effects of Iron Dextran

Most common

• Abdominal or stomach discomfort
• low blood pressure,
• difficult, burning, or painful urination
• increased potassium blood levels (hyperkalemia),
• low blood sugar? (hypoglycemia?), and
• diarrhea
• symptoms of weakness?, muscle pain (myalgia)
• abdominal pain (GI complaints), lactic acidosis (rare)
• low blood levels of vitamin B-12
• nausea,vomiting
• chest discomfort
• chills?, dizziness
• bloating?/abdominal distention
• constipation
• heartburn?

More common

• chest pain;
• Abdominal or stomach discomfort
• a cough or hoarseness?
• decreased appetite
• diarrhea
• fast or shallow breathing
• feeling like you might pass out;
• swelling? in your hands, ankles, or feet;
• trouble breathing; or
• dangerously high blood pressure (a severe headache, blurred vision?, buzzing in your ears, anxiety, confusion?, chest pain?, shortness of breath, uneven heartbeats, seizure)
• lower back or side pain
• muscle pain or cramping
• painful or difficult urination

Less common

• muscle cramps;
• weakness, tired feeling;
• dizziness, anxiety, headache;
• nausea, vomiting, stomach pain;
• diarrhea, constipation;
• ear pain;
• sore throat, sinus pain or congestion;
• decreased sense of taste;
• joint pain; or
• pain, swelling, burning, or irritation around the IV needle.
• Bloating or swelling of the face, arms, hands, lower legs, or feet
• blurred vision
• chest pain or tightness in the chest
• confusion
• difficult or labored breathing
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• nervousness
• pounding in the ears
• rapid weight gain

Drug Interactions of Iron Dextran

Large doses of iron dextran (5 mL or more) have been reported to give a brown color to serum from a blood sample drawn 4 hours after administration.

The drug may cause falsely elevated values of serum bilirubin and falsely decreased values of serum calcium. Serum iron determinations (especially by colorimetric assays) may not be meaningful for 3 weeks following the administration of iron dextran. Serum ferritin peaks approximately 7 to 9 days after an intravenous dose of INFeD and slowly returns to baseline after about 3 weeks.

Examination of the bone marrow for iron stores may not be meaningful for prolonged periods following iron dextran therapy because residual iron dextran may remain in the reticuloendothelial cells.

Bone scans involving 99m Tc-diphosphonate have been reported to show a dense, crescentic area of activity in the buttocks, following the contour of the iliac crest, 1 to 6 days after intramuscular injections of iron dextran. Bone scans with 99m Tc-labeled bone-seeking agents, in the presence of high serum ferritin levels or following iron dextran infusions, have been reported to show a reduction of bony uptake, marked renal activity, and excessive blood pool and soft tissue accumulation.

This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

• ferrous fumarate;
• ferrous gluconate; or
• ferrous sulfate, and others.

This list is not complete. Other drugs may interact with iron sucrose, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Pregnancy & Lactation of 

FDA Pregnancy Category C

Pregnancy

This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while receiving this medication, contact your doctor immediately.

Lactation

This medication passes into breast milk. If you are a breastfeeding mother and are using iron dextran, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

References