Names and pronunciation
Dexiron , INFeD
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Drug reference
Dexiron , INFeD
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Func. class.: Hematinic
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Chem. class.: Ferric hydroxide complex with dextran
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ACTION: Iron is carried by transferrin to the bone marrow, where it is incorpo- rated into hemoglobin
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USES: Iron-deficiency anemia
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CONTRAINDICATIONS: Repeated blood transfusions, vitamin E deficiency
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Black Box Warning: Hypersensitivity Precautions: Pregnancy, breastfeeding, neonates, infants <4 mo, children, acute renal disease, asthma, rheumatoid arthritis (IV), ankylosing spondylitis, lupus, hypotension, all anemias exclud- ing iron-deficiency anemia, hepatic/car- diac/renal disease Black Box Warning: Allergy: anaphy- laxis, rash, pruritus, fever, chills, wheez- ing; notify prescriber immediately, keep emergency equipment available • Cardiac status: anginal pain, hypoten- sion, tachycardia • Nutrition: amount of iron in diet (meat, dark green leafy vegetables, dried beans, dried fruits, eggs) • Cause of iron loss or anemia, including use of salicylates, sulfonamides • Toxicity: nausea, vomiting, diarrhea, fever, abdominal pain (early symptoms), cyanotic-looking lips, nailbeds, seizures, CV collapse (late symptoms) • Pregnancy/breastfeeding: use only if benefit outweighs fetal risk; use caution in breastfeeding, trace amounts appear in breast milk
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SIDE EFFECTS CNS: Headache, paresthesia, dizziness, shivering, weakness, seizures CV: Chest pain, shock, hypotension, tachycardia GI: Nausea, vomiting, metallic taste, abdominal pain HEMA: Leukocytosis INTEG: Rash, pruritus, urticaria, fever, sweating, chills, brown skin discolor- ation, pain at inj site, necrosis, sterile abscesses, phlebitis OTHER: Anaphylaxis RESP: Dyspnea
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INTERACTIONS Increase: toxicity—oral iron; do not use Decrease: reticulocyte response— chloramphenicol Drug/Lab Test False increase: serum bilirubin False decrease: serum calcium False positive: 99mTc diphosphate bone scan, iron test (large doses >2 mL)
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TREATMENT OF OVERDOSE: Discontinue product, treat allergic reac- tion, give diphenhydrAMINE or EPINEPH- rine as needed, give iron-chelating prod- uct for acute poisoning
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DOSAGE AND ROUTES • Adult/child: IM 0.5 mL as a test dose by Z-track, then no more than the follow ing total dose including test dose per day: • Adult/adolescent/child (>15 kg): Total iron dextran dose in mL = [0.0442 × I (Desired Hb − observed Hb) × LBW] + (0.26 × LBW), max of undiluted is 100 mg (2 mL)/day • Child (10-15 kg): Total iron dextran dose in mL = [0.0442 × (Desired Hb − observed Hb) × LBW] + (0.26 × ABW), max of undiluted iron dextran is 100 mg (2 mL)/day • Child/Infant >4 mo (5-9.9 kg): Total iron dextran dose in mL = [0.0442 × (Desired Hb − observed Hb) × LBW] + (0.26 × ABW) • Infants >4 mo (<5 kg): Total iron dextran dose in mL = [0.0442 × (De- sired Hb − observed Hb) × LBW] + (0.26 × ABW)
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Administer: • D/C oral iron before parenteral; give only after test dose of 25 mg by preferred route; wait at least 1 hr before giving re- maining portion • Store at room temperature in cool en- vironment • Recumbent position 30 min after IV inj to prevent orthostatic hypotension IM route • IM deeply in large muscle mass; use Z-track method, 19- to 20-G 2- to 3-in needle; ensure needle long enough to place product deep in muscle; change needles after withdrawing product and before injecting to prevent skin, tissue staining • Only with EPINEPHrine available in case of anaphylactic reaction during dose IV route • IV after flushing with 10 mL 0.9% NaCl; give undiluted; may be diluted in 50-250 mL NS for infusion; give ≤1 mL (50 mg) over ≥1 min; flush line after use with 10 mL 0.9% NaCl; patient should remain recumbent for ½-1 hr • IV inj requires single-dose vial without preservative; verify on label that IV use approved
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Assess: • Observe for 1 hr after first dose to monitor for anaphylactic reactions • Blood studies: Hct, HB, reticulocytes, transferrin, plasma iron concentrations, ferritin, total iron binding, bilirubin be- fore treatment, at least monthly
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Evaluate: • Therapeutic response: increased se- rum iron level, increased HB, Hct
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That iron poisoning may occur if in creased beyond recommended level; not to take oral iron preparation or vitamins containing iron • That delayed reaction may occur 1-2 days after administration and last 3-4 days (IV), 3-7 days (IM); to report fever, chills, malaise; muscle, joint aches; nau sea, vomiting, backache • To avoid breastfeeding • That stools may become dark
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PHARMACOKINETICS IM: Excreted in feces, urine, bile, breast milk; crosses placenta; most absorbed through lymphatics; can be gradually absorbed over weeks/months from fixed locations
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• Adult/adolescent/child (>15 kg): Total iron dextran dose in mL = [0.0442 × I (Desired Hb − observed Hb) × LBW] + (0.26 × LBW), max of undiluted is 100 mg (2 mL)/day
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