Infed (iron dextran complex)

Dosage of iron dextran is expressed in terms of mg of elemental iron. Iron dextran injection contains the equivalent of 50 mg of elemental iron per mL.

Iron dextran injection is administered undiluted by slow (50 mg/minute or less if undiluted) IV injection; some preparations (i.e., INFeD(R)) also are FDA-labeled for IM injection. Iron dextran injection also has been diluted in 0.9% sodium chloride injection and administered by IV infusion+ (e.g., over 1-6 hours).

Before administration of the first therapeutic dose of iron dextran, a test dose of iron should be given by the chosen route and appropriate method of administration. If iron dextran is to be administered IV, the manufacturer of INFeD(R) recommends that a test dose of 25 mg (0.5 mL) of iron dextran be given IV over at least 30 seconds; the manufacturer of Dexferrum(R) recommends a 25-mg (0.5 mL) test dose given IV over at least 5 minutes. If administered IM, a test dose of 25 mg (0.5 mL) of iron dextran (InFeD(R)) should be administered into the buttock using the IM injection technique recommended by the manufacturer. It has been recommended that the test dose and subsequent doses of iron dextran be administered by individuals trained to provide emergency treatment of serious allergic reactions should they occur and that immediate access to drugs and resuscitation equipment needed to treat such reactions be available. Although anaphylactic reactions usually are evident within a few minutes when they occur, it is recommended that a period of 1 hour or longer elapse before the remaining portion of the initial dose is given.

IV administration may be preferred to IM administration when there is insufficient muscle mass for IM administration, when there is impaired absorption from the muscle because of stasis or edema, when there is a possibility of uncontrolled IM bleeding (as in hemophilia), or when massive and prolonged parenteral therapy is indicated (as in chronic substantial blood loss), and to avoid the pain, irritation, and staining of the skin at the injection site secondary to IM administration. IM administration may be preferred when venous access is difficult or infeasible (e.g., in infants or in adults with poor veins).

For IM administration, the manufacturer of INFeD(R) recommends that iron dextran be injected deeply with a 2- or 3-inch, 19- or 20-gauge needle into the upper outer quadrant of the buttock only; the drug should never be administered into the arm or any other exposed area. When the drug is administered IM, if the patient is standing, the injection should be made in the buttock of the leg opposite the patient's weight-bearing leg; if supine, the patient should be in a lateral position with the injection site uppermost. To avoid injection or leakage into subcutaneous tissue, the Z-track technique of injection in which the subcutaneous tissue over the site of injection is firmly pushed aside before inserting the needle is recommended.

The manufacturers state that iron dextran should not be mixed with other drugs or added to parenteral nutrition solutions for IV infusion. Iron dextran solutions should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.

No dosing information is available for this tab.

There is no enhanced messaging for this drug.

Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

Iron/Dimercaprol

SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

MECHANISM OF ACTION: Dimercaprol can complex with iron, forming a chelation compound that is more toxic than iron alone.(1)

CLINICAL EFFECTS: Concurrent use of dimercaprol and iron may result in toxicity, especially renal toxicity.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Medicinal iron should not be administered to patients receiving dimercaprol.(1)

DISCUSSION: Because the dimercaprol-iron complex is more toxic than iron alone, especially to the kidneys, medicinal iron should not be administered to patients receiving dimercaprol.(1)

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

There is no enhanced messaging for this drug.

• Hemochromatosis

• Ankylosing spondylitis
• Asthma
• Chronic iron overload
• Hemolytic anemia
• Hemosiderosis
• Pyelonephritis
• Severe hepatic disease
• Systemic lupus erythematosus

• Rheumatoid arthritis

There is no enhanced messaging for this drug.

Less Frequent

• Infection
• Thrombotic disorder

Rare or Very Rare

• Acute myocardial infarction
• Anaphylaxis
• Angina
• Bradycardia
• Bronchospastic pulmonary disease
• Cyanosis
• Dyspnea
• Extravasation injury
• Hemoglobinuria
• Hemolysis
• Hemorrhage
• Hypersensitivity drug reaction
• Hypertension
• Hypotension
• Leukocytosis
• Pneumonia
• Pulmonary edema
• Seizure disorder
• Sepsis
• Urticaria

More Frequent

• Cramps
• Dyschromia
• Dysgeusia
• Headache disorder
• Hyperhidrosis
• Hypoesthesia

Less Frequent

• Pharyngitis
• Rhinitis

Rare or Very Rare

• Acute abdominal pain
• Acute cognitive impairment
• Anorexia
• Arthralgia
• Arthritis
• Back pain
• Chest pain
• Chills
• Constipation
• Cough
• Cramps in legs
• Diarrhea
• Dizziness
• Dyspepsia
• Eructation
• Fatigue
• Fever
• Flatulence
• Flu-like symptoms
• Flushing
• General weakness
• Hematuria
• Hypertonia
• Injection site sequelae
• Lymphadenopathy
• Myalgia
• Nausea
• Nervousness
• Pain
• Pallor
• Palpitations
• Paresthesia
• Peripheral edema
• Phlebitis after infusion
• Pruritus of skin
• Purpura
• Rectal pain
• Skin rash
• Tachycardia
• Upper respiratory infection
• Urinary tract infection
• Vasodilation of blood vessels
• Vomiting
• Xerostomia

No enhanced messaging available.

No enhanced messaging available.

Reproduction studies in mice, rats, rabbits, dogs, and monkeys using iron dextran doses about 3 times the maximum human dose have shown the drug to be teratogenic and embryocidal. At doses equivalent to 50 mg/kg or less of iron, no consistent adverse fetal effects were observed in mice, rats, rabbits, dogs, or monkeys. At a total IV dose equivalent to 90 mg/kg of iron given over a 14-day period, fetal and maternal toxicity has been reported in monkeys; similar effects were observed in mice and rats with a single dose equivalent to 125 mg/kg of iron. In dogs and rats, fetal abnormalities were observed at doses equivalent to 250 mg/kg or higher of iron. The animals used in reproduction studies were not iron deficient. The effect of iron dextran on the human fetus is not known. Results of various studies in pregnant animals and humans have been inconclusive regarding placental transfer of intact iron dextran. Small amounts of iron apparently cross the placenta (the form in which it crosses the placenta has not been clearly established) and increase neonatal serum iron concentrations when iron dextran is administered within 2 weeks of delivery; however, no adverse effects on the neonate have been reported. There are no adequate and well-controlled studies using iron dextran in pregnant women, and the drug should be used during pregnancy only when the potential benefits justify the possible risks to the fetus.

Only traces of unmetabolized iron dextran are distributed into milk, but the drug should be used with caution in nursing women.

No enhanced messaging available.