Flushing and hypotension are more common following rapid intravenous administration; do not exceed recommended IV infusion rates. Patients with preexisting cardiac disease may have exacerbation of cardiovascular symptoms if adverse effects occur following iron dextran administration.
Iron dextran is contraindicated for use in patients with anemia not associated with iron deficiency. Do not administer iron dextran to patients with evidence of iron overload e. Unnecessary or prolonged administration of iron may lead to iron overload and consequently the possibility of exogenous hemosiderosis.
Patients with hemoglobinopathy and other refractory anemias that might be erroneously diagnosed as iron deficiency anemias are at particular risk for such iron overload. The type of anemia and the underlying cause or causes should be determined before starting therapy with parenteral iron dextran.
Since the anemia may be a result of a systemic disturbance, such as recurrent blood loss, the underlying cause s should be corrected, if possible. Patients receiving exogenous iron therapy require periodic monitoring of hematologic and hematinic parameters i.
Hemosiderosis secondary to long-term iron dextran treatment has primarily been reported in patients with renal failure receiving dialysis. Periodic monitoring of serum ferritin levels may be helpful in recognizing a progressive accumulation of iron resulting from impaired iron uptake from the reticuloendothelial system in patients with renal failure. The contribution of iron to infectious processes is unclear, but iron dextran should not be administered during the acute phase of infectious renal disease manufacturer's information.
Some patients with chronic hepatic disease may also have hemochromatosis or moderate iron overload in hepatic tissues. The liver is one of the main storage sites for iron, and advanced chronic liver disease may result in excess storage iron in the liver. Use iron dextran with caution in patients with hepatic disease. Use of iron dextran in infants younger than 4 months of age and neonates is not recommended; there have been reports from other countries of an increased incidence of gram-negative sepsis e.
In general, iron supplementation should not begin in premature infants until adequate vitamin E is supplied in the diet; human breast milk and modern infant formulas usually supply adequate dietary vitamin E.
Fetal adverse reactions, including fetal bradycardia, have been associated with maternal hypersensitivity reactions to parenteral iron products, especially during the second and third trimester of pregnancy. There are no adequate and well-controlled studies of iron dextran in pregnant women.
Administer iron dextran during pregnancy only if the potential benefit outweighs the potential risk to the fetus. Various human and animal studies have demonstrated inconclusive results regarding the ability of iron dextran to cross the placenta; it appears some iron does reach the fetus, but the form in which it crosses the placenta is not clear. Iron dextran has been shown to be teratogenic and embryocidal in animals mice, rats, rabbits, dogs, and monkeys when given in doses approximately 3 times the maximum human dose.
While iron is excreted into breast-milk, the iron content of breast milk is not readily affected by the iron content of the maternal diet or the maternal serum iron level. Therefore, the therapeutic prescription use of iron is usually compatible with breast-feeding if the lactating mother needs treatment for iron deficiency.
However, trace amounts of unmetabolized iron dextran are excreted in breast milk. According to FDA-approved labeling, caution should be exercised if iron dextran is administered to a nursing mother.
Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA. Laboratory test interference may occur with iron dextran therapy. Specifically, the drug may cause falsely elevated concentrations of serum bilirubin and falsely decreased concentrations of serum calcium.
Additionally, the drug may affect bone scans. 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 concentrations 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. Amlodipine; Benazepril: Moderate The concomitant use of angiotensin-converting enzyme inhibitors ACE inhibitors with iron dextran may increase the risk for anaphylactic-type reactions.
The factors that affect the risk for anaphylactic-type reactions to iron dextran products are not fully known but limited clinical data suggest the risk may be increased among patients with a history of drug allergy or multiple drug allergies. Patients should be monitored for signs and symptoms of anaphylactic-type reactions during all iron dextran administrations. Angiotensin-converting enzyme inhibitors: Moderate The concomitant use of angiotensin-converting enzyme inhibitors ACE inhibitors with iron dextran may increase the risk for anaphylactic-type reactions.
Benazepril: Moderate The concomitant use of angiotensin-converting enzyme inhibitors ACE inhibitors with iron dextran may increase the risk for anaphylactic-type reactions. Benazepril; Hydrochlorothiazide, HCTZ: Moderate The concomitant use of angiotensin-converting enzyme inhibitors ACE inhibitors with iron dextran may increase the risk for anaphylactic-type reactions.
Captopril: Moderate The concomitant use of angiotensin-converting enzyme inhibitors ACE inhibitors with iron dextran may increase the risk for anaphylactic-type reactions.
Captopril; Hydrochlorothiazide, HCTZ: Moderate The concomitant use of angiotensin-converting enzyme inhibitors ACE inhibitors with iron dextran may increase the risk for anaphylactic-type reactions.
Darbepoetin Alfa: Minor It is important that iron stores be replete before beginning therapy with darbepoetin alfa due to increased iron utilization. Inadequate iron stores will interfere with the therapeutic response to these agents e.
Supplemental iron may be needed during maintenance therapy to facilitate erythropoiesis. Iron supplementation e. Deferasirox: Major Deferasirox chelates iron and is indicated as a treatment of iron toxicity or overdose. It would be illogical for a patient to receive both iron supplementation and deferasirox simultaneously.
Deferiprone: Major Deferiprone chelates iron. Therapeutically, it is typically illogical for a patient to receive both iron supplementation e. Concurrent use of deferiprone with iron supplements has not been studied. Since deferiprone has the potential to bind polyvalent cations e. Deferoxamine: Contraindicated Deferoxamine chelates iron from ferritin or hemosiderin.
A stable complex is formed that prevents iron from entering into further chemical reactions. The chelate is excreted in the urine and in the feces via bile. Deferoxamine is indicated as a treatment of iron toxicity or overdose. It would be illogical for a patient to receive both iron supplementation and deferoxamine simultaneously. Dimercaprol: Contraindicated Dimercaprol forms toxic chelates with iron.
These dimercaprol-iron complexes are more toxic than the metal alone, especially to the kidneys. Do not administer iron during dimercaprol treatment. Therapy with iron should generally be delayed until 24 hours after the cessation of dimercaprol therapy.
Enalapril, Enalaprilat: Moderate The concomitant use of angiotensin-converting enzyme inhibitors ACE inhibitors with iron dextran may increase the risk for anaphylactic-type reactions. Enalapril; Felodipine: Moderate The concomitant use of angiotensin-converting enzyme inhibitors ACE inhibitors with iron dextran may increase the risk for anaphylactic-type reactions.
Enalapril; Hydrochlorothiazide, HCTZ: Moderate The concomitant use of angiotensin-converting enzyme inhibitors ACE inhibitors with iron dextran may increase the risk for anaphylactic-type reactions. Epoetin Alfa: Minor Inadequate iron stores will interfere with the therapeutic response to epoetin alfa e. Most patients with chronic kidney disease will require supplemental iron e. Evaluate transferrin saturation and serum ferritin before and during epoetin alfa treatment.
Administer supplemental iron therapy when serum ferritin is Fosinopril: Moderate The concomitant use of angiotensin-converting enzyme inhibitors ACE inhibitors with iron dextran may increase the risk for anaphylactic-type reactions.
Fosinopril; Hydrochlorothiazide, HCTZ: Moderate The concomitant use of angiotensin-converting enzyme inhibitors ACE inhibitors with iron dextran may increase the risk for anaphylactic-type reactions. Hydrochlorothiazide, HCTZ; Moexipril: Moderate The concomitant use of angiotensin-converting enzyme inhibitors ACE inhibitors with iron dextran may increase the risk for anaphylactic-type reactions. Iron: Major Parenteral iron formulas are generally only indicated for use in patients with documented iron deficiency in whom oral administration is either impossible or unsatisfactory.
In general, do not administer parenteral iron concomitantly with other iron preparations e. Parenteral iron preparations e. It will take at least 15 minutes for the infusion to go through. Some iron injections can be given into a muscle called intramuscular injections , but these are not used often because they are painful and can stain the skin. Tip: Do not take iron tablets for a week after an iron infusion because the iron in them will not be absorbed by your body. The dose needed will be different for each person.
Your doctor will calculate how much iron is needed to return your levels to normal. The iron will take a few weeks to have its full effect. You can be given an iron infusion at your GP surgery, clinic or hospital. On the day of the infusion, eat your meals as usual and take your regular medicines.
Like all medicines, iron infusions can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine. Other signs may include changes in color of the skin of the face, very fast but irregular heartbeat or pulse, hive-like swellings on the skin, and puffiness or swellings of the eyelids or around the eyes.
If these side effects occur, get emergency help at once. Tell your doctor right away if you have the following symptoms after receiving this medicine: chills, backache, dizziness, headache, moderate to high fever, joint or muscle pain, nausea, or vomiting.
Tell any doctor or dentist who treats you that you are using this medicine. This medicine may affect certain medical test results. Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription over-the-counter [OTC] medicines and herbal or vitamin supplements. Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.
Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:. Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. Call your doctor for medical advice about side effects. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.
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