IRON DEXTRAN

IRON DEXTRAN
(i'ern dek'stran)
DexFerrum, INFeD, Proferdex
Classifications: blood former; iron preparation; antianemic;
Therapeutic: antianemic
; iron supplement
Prototype: Ferrous sulfate
Pregnancy Category: C

Availability

50 mg elemental iron/mL

Action

A dark brown, slightly viscous liquid complex of ferric hydroxide with dextran in 0.9% NaCl solution for injection. Reticuloendothelial cells of liver, spleen, and bone marrow dissociate iron from iron dextran complex. The released ferric ion combines with transferrin and is transported to bone marrow, where it is incorporated into hemoglobin.

Therapeutic Effect

Effective in replacement of iron needed in iron deficiency anemia, thus replenishing hemoglobin and depleted iron stores.

Uses

Only in patients with clearly established iron deficiency anemia when oral administration of iron is unsatisfactory or impossible.

Contraindications

Hypersensitivity to the product; all anemias except iron-deficiency anemia; acute phase of infectious renal disease; pregnancy (category C); infants <5 kg, and neonates.

Cautious Use

Rheumatoid arthritis, ankylosing spondylitis; renal disease; SLE; impaired hepatic function; cardiac disease; history of allergies or asthma.

Route & Dosage

Iron Deficiency
Adult: IM/IV Dose is individualized and determined based on patient's weight and hemoglobin (see package insert); do not administer more than 100 mg (2 mL) of iron dextran within 24 h
Child: IM/IV <5 kg, no more than 0.5 mL (25 mg)/d; 5–10 kg, no more than 1 mL (50 mg)/d; >10 kg, no more than 2 mL (100 mg)/d

Administration

Note: The multiple-dose vial is used ONLY for IM injections. It is not suitable for IV use because it contains a preservative (phenol).

Test Dose
  • Give a test dose of 0.5 mL over a 5 min period before the first IM or IV therapeutic dose to observe patient's response to the drug. Have epinephrine (0.5 mL of a 1:1000 solution) immediately available for hypersensitivity emergency.
  • Note: Although anaphylactic reactions (see Appendix F) usually occur within a few minutes after injection, it is recommended that 1 h or more elapse before remainder of initial dose is given following test dose.
Intramuscular
  • Use the multiple-dose vial ONLY for IM injections. It is not suitable for IV use because it contains a preservative (phenol).
  • Give injection only into the muscle mass in upper outer quadrant of buttock (never in the upper arm). In small child, use the lateral thigh. Use a 2- or 3-inch, 19- or 20-gauge needle. The Z-track technique is recommended. Use one needle to withdraw drug from container and another needle for injection.
  • Note: If patient is receiving IM in standing position, patient should be bearing weight on the leg opposite the injection site; if in bed, patient should be in the lateral position with injection site uppermost.
Intravenous
  • Ensure that ONLY the vial for IV use is selected.

PREPARE: Direct: Give undiluted.  IV Infusion: Dilute in 250–1000 mL of NS.  

ADMINISTER: Direct: ?? Test Dose: a test dose is give before the first IV therapeutic dose. ?? DexFerrum: Give test dose of 25 mg (0.5 mL) slowly over 5 min. ?? INFeD: Give test dose over 30 sec. Wait 1–2 h and if no adverse reaction occurs, give the remainder of the first dose by IV infusion. IV Infusion: Infuse at a rate not to exceed 50 mg (1 mL) or fraction thereof over 60 sec. Avoid rapid infusion.  

INCOMPATIBILITIES Solution/additive: TPN.

  • After infusion is completed, flush vein with 10 mL of NS.
  • Have patient remain in bed for at least 30 min after IV administration to prevent orthostatic hypotension. Monitor BP and pulse.
  • Store below 30° C (86° F) unless otherwise directed.

Adverse Effects (≥1%)

Body as a Whole: Hypersensitivity (urticaria, skin rash, allergic purpura, pruritus, fever, chills, dyspnea, arthralgia, myalgia; anaphylaxis). CNS: Headache, shivering, transient paresthesias, syncope, dizziness, coma, seizures. CV: Peripheral vascular flushing (rapid IV), hypotension, precordial pain or pressure sensation, tachycardia, fatal cardiac arrhythmias, circulatory collapse. GI: Nausea, vomiting, transient loss of taste perception, metallic taste, diarrhea, melena, abdominal pain, hemorrhagic gastritis, intestinal necrosis, hepatic damage. Skin: Sterile abscess and brown skin discoloration (IM site), local phlebitis (IV site), lymphadenopathy, pain at IM injection site. Metabolic: Hemosiderosis, metabolic acidosis, hyperglycemia, reactivation of quiescent rheumatoid arthritis, exogenous hemosiderosis. Hematologic: Bleeding disorder with severe toxicity.

Diagnostic Test Interference

Falsely elevated serum bilirubin and falsely decreased serum calcium values may occur. Large doses of iron dextran may impart a brown color to serum drawn 4 h after iron administration. Bone scans involving Tc-99m diphosphonate have shown dense areas of activity along contour of iliac crest 1–6 d after IM injections of iron dextran.

Interactions

May decrease absorption of oral iron, chloramphenicol may decrease effectiveness of iron, a toxic complex may form with dimercaprol.

Pharmacokinetics

Absorption: 60% from IM site by 3 d; 90% absorbed by 1–3 wk. Distribution: Crosses placenta; distributed into breast milk. Metabolism: In reticuloendothelial system. Half-Life: 6 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor for therapeutic effectiveness: Anticipated response to parenteral iron therapy is an average weekly hemoglobin rise of about 1 g/d. Peak levels are generally reached in about 4–8 wk.
  • Note: Systemic reactions may occur over 24 h after parenteral iron has been administered. Large IV doses are associated with increased frequency of adverse effects.
  • Lab tests: Periodic determinations of Hgb and Hct, and reticulocyte count should be made.

Patient & Family Education

  • Do not take oral iron preparations when receiving iron injections.
  • Eat foods high in iron and vitamin C.
  • Notify physician of any of the following: backache or muscle ache, chills, dizziness, fever, headache, nausea or vomiting, paresthesias, pain or redness at injection site, skin rash or hives, or difficulty breathing.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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