Product Details

(iron DEX-tran)

DexFerrum, InFeD,  Infufer

Class: Iron product

 Action Replenishes Hgb and depleted iron stores.

 Indications Treatment of iron deficiency anemia when oral administration of iron is unsatisfactory or impossible. Unlabeled use(s): Use with epoetin to ensure hematological response to epoetin.

 Contraindications Anemia not associated with iron deficiency.

 Route/Dosage

Prior to the first IV or IM iron dextran injection, give a 0.5 ml test dose by the same route, respectively. Anaphylactic reactions occurring following iron dextran injection are usually evident within a few minutes; however, at least 1 hr should elapse before the remainder of the therapeutic dose is given.

Iron Deficiency Anemia

ADULTS & CHILDREN: IM/IV with dose based on formula to determine amount of iron required to restore hemoglobin to normal levels (max 2 ml/day undiluted iron dextran):

£ 30 lb.

Iron Replacement for Blood Loss

ADULTS & CHILDREN: TEST DOSE: IM/IV with dose based on formula that 1 ml of normocytic, normochromic RBC cells contains 1 mg of elemental iron (maximum 2 ml/day undiluted iron dextran):

Mg iron — blood loss (ml) × Hct

Each day's dose should not exceed 0.5 ml (25 mg iron) for infants < 10 lb or 1 ml (50 mg iron) for children < 20 lb, or 2 ml (100 mg iron) for other patients.

 Interactions

Chloramphenicol: May increase serum iron concentrations. INCOMPATIBILITIES: Do not mix with other medications or add to parenteral nutrition solutions for IV infusions.

 Lab Test Interferences Serum bilirubin: Drug may cause falsely elevated values. Serum calcium: Drug may cause falsely decreased values.

 Adverse Reactions

CV: Hypotension; peripheral vascular flushing (IV). CNS: Headache; dizziness; malaise; transitory paresthesias. DERM: Brown skin discoloration at IM injection site. GI: Nausea. HEMA: Leukocytosis. OTHER: Hypersensitivity (eg, fatal anaphylaxis, shortness of breath, urticaria, itching, arthralgia, myalgia, fever); pain and inflammation at injection site; sterile abscesses (IM); phlebitis at IV injection site; reactivation of arthritis in patients with inactive rheumatoid arthritis; backache; shivering. Delayed reactions may occur 1 to 2 days after administration.

 Precautions

Pregnancy: Safety not established. Based on animal studies, avoid if possible. Lactation: Undetermined. Children: Not recommended in children < 4 mo. Allergies/Asthma: Use drug with caution in patients with history of significant allergies/asthma. Arthritis: Patients with iron deficiency anemia and rheumatoid arthritis may have acute exacerbation of joint pain and swelling after IV administration. Hepatic impairment: Use drug with extreme caution in severe hepatic impairment. Hypersensitivity: Hypersensitivity, including anaphylaxis, may occur. Have epinephrine immediately available.

 Administration/Storage

• Oral iron preparations should be discontinued before parenteral administration.
• Inject IM via Z-track technique into upper outer quadrant of buttock; never inject iron dextran into arm or other exposed areas. Use 2- to 3-inch 19- or 20-gauge needle.
• If patient is standing, weight should be placed on leg opposite injection site. If in bed, patient should be in lateral position with injection site uppermost.
• Change needles between withdrawal from container and injection to minimize staining of SC tissues. Stains usually are permanent.
• For IV administration, inject slowly at £ 1 ml/min.
• Store at room temperature.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess patient's nutritional status and dietary history to determine possible causes of anemia.
• Monitor Hgb, Hct, and reticulocyte values; transferrin, ferritin, total ironbinding capacity; and plasma iron concentrations periodically during therapy.
• Assess patient for signs of anaphylaxis (eg, rash, pruritus, laryngeal edema, wheezing).
• Monitor BP and heart rate frequently during IV administration.
• Assess patient for symptoms of GI distress and constipation regularly throughout therapy.
• Provide diet high in iron (eg, organ meats; leafy, green vegetables; dried beans and peas; dried fruit; cereals).
• If constipation occurs, obtain order for laxative. Increase fiber and give additional fluids.

 Patient/Family Education

• Teach family and patient the name, dose, action, and side effects of iron.
• Advise patient to take additional fluids to prevent constipation.
• Teach patient that certain foods, such as coffee, tea, eggs, and milk, interact with iron.
• Teach patient and family the daily iron requirements (children 6 mo to 10 yr: 10 mg; adolescents 11 to 18 yr, male: 12 mg; adolescents 11 to 18 yr, female: 15 mg; adult women, pregnant: 30 mg; adult women, nonpregnant: 15 mg; adult men: 10 mg).

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