IV iron preparations: test dose, dosage, side effects, and average wholesale pricing
| Iron preparation . | Test dose . | Usual dosage for adults . | Most common side effects . | Estimated AWP (US dollars) . | Observations32 . |
|---|---|---|---|---|---|
| Iron sucrose/iron saccharate | Not recommended; If history of drug allergies, consider test dose with 25-mg IV, slow push. | 1000 mg per treatment; 10 doses of 100 mg IV 2-5 min in consecutive hemodialysis sessions; 5 doses of 200 mg within 14 d or weekly, by IV 2-5 min or in 100 mL NS infusion for >15 min. | >20%: hypotension and muscle cramps in hemodialysis patients; 10-20%: nausea, headache, nasopharyngitis; 1-10%: hypotension, hypertension, edema, chest pain, dizziness, pruritus, GI symptoms, injection site reaction, myalgia, conjunctivitis, dyspnea, cough, fever. | $432.00 (1000 mg Venofer) | 1-wk interval recommended before MRI. |
| LMW iron dextran | Recommended before the first dose; 25 mg (0.5 mL) IV push for 30 s; observe for 1 h. | 1000 mg per treatment; 10 doses of 100 mg >2-min undiluted IV infusion daily; Single dose of 1000 mg 1-h IV infusion in 250 mL NS (off label).35 | Incidence unknown: hypotension, flushing, headache, urticaria, GI symptoms, anaphylaxis, injection site reaction, myalgia, dyspnea, wheezing, fever. | $350.60 (1000 mg INFeD) | Not to be confused with high-molecular-weight dextran (discontinued); 4-wk interval recommended before MRI. |
| Ferric gluconate | Previously recommended, but currently not on label; If history of drug allergies, consider test dose with 25 mg (2 mL) in 50 mL NS for 60-min infusion. | 1000 mg per treatment; 8 doses of 125 mg IV bolus undiluted for 10 min for patients in hemodialysis or 1-h infusion in 100 mL NS. | >20%: hypotension, vomiting, nausea, headache, diarrhea, injection site reaction, muscle cramps; 10-20%: dizziness, tachycardia, hypertension, dyspnea; 1-10%: chest pain, thrombosis, edema, pruritus, hyperkalemia, abdominal pain, pharyngitis, cough, fever; <1%: flushing, hypersensitivity reaction. | $610.40 (1000 mg Ferrlecit) | 1-wk interval recommended before MRI. |
| Ferumoxytol | Not recommended | 1020 mg per treatment; 2 doses of 510 mg, >15 min infusion in 50-250 mL NS or 5% dextrose, 3-8 d apart or single 1020-mg dose, 30-min infusion; Observation for 30 min after infusion recommended. | 1-10%: hypotension, edema, chest pain, hypertension, dizziness, headache, pruritus, rash, diarrhea, nausea, constipation, vomiting, abdominal pain, hypersensitivity reaction, cough, dyspnea, fever. | $2571.42 (1020 mg of Feraheme) | 12- (US) to 24- (Europe) wk interval recommended before MRI. |
| FCM | Not recommended | 1500 mg per treatment; 2 doses of 750 mg undiluted IV at 100 mg/min, or in 250 mL NS 15-min infused 7 d apart; Observation recommended for 30 min after infusion. | >10%: hypophosphatemia (<2 mg/dL); 1% to 10%: hypertension, hypotension, flushing, skin discoloration at injection site, nausea, vomiting, abdominal pain, increased ALT, dizziness, headache; <1%: abdominal pain, anaphylaxis, diarrhea, increased GGT, injection site reaction, paresthesia, skin rash, sneezing. | $2735.10 (1500 mg of Injectafer) | Verification of phosphate levels is recommended for repeated infusions; 1-wk interval recommended before MRI. |
| Ferric derisomaltose | Not recommended | 1000-mg single dose in 100-500 mL NS with a final concentration >1 mg iron/mL, infused over >20 min. | 1-10%: hypophosphatemia, skin rash, nausea; <1%: asthma, severe hypersensitivity reaction. | $2957.10 USD (1000 mg of Monoferric) | Previously iron isomaltoside; verification of phosphate levels is recommended for repeated infusions; 4-wk interval recommended before MRI. |
| Iron preparation . | Test dose . | Usual dosage for adults . | Most common side effects . | Estimated AWP (US dollars) . | Observations32 . |
|---|---|---|---|---|---|
| Iron sucrose/iron saccharate | Not recommended; If history of drug allergies, consider test dose with 25-mg IV, slow push. | 1000 mg per treatment; 10 doses of 100 mg IV 2-5 min in consecutive hemodialysis sessions; 5 doses of 200 mg within 14 d or weekly, by IV 2-5 min or in 100 mL NS infusion for >15 min. | >20%: hypotension and muscle cramps in hemodialysis patients; 10-20%: nausea, headache, nasopharyngitis; 1-10%: hypotension, hypertension, edema, chest pain, dizziness, pruritus, GI symptoms, injection site reaction, myalgia, conjunctivitis, dyspnea, cough, fever. | $432.00 (1000 mg Venofer) | 1-wk interval recommended before MRI. |
| LMW iron dextran | Recommended before the first dose; 25 mg (0.5 mL) IV push for 30 s; observe for 1 h. | 1000 mg per treatment; 10 doses of 100 mg >2-min undiluted IV infusion daily; Single dose of 1000 mg 1-h IV infusion in 250 mL NS (off label).35 | Incidence unknown: hypotension, flushing, headache, urticaria, GI symptoms, anaphylaxis, injection site reaction, myalgia, dyspnea, wheezing, fever. | $350.60 (1000 mg INFeD) | Not to be confused with high-molecular-weight dextran (discontinued); 4-wk interval recommended before MRI. |
| Ferric gluconate | Previously recommended, but currently not on label; If history of drug allergies, consider test dose with 25 mg (2 mL) in 50 mL NS for 60-min infusion. | 1000 mg per treatment; 8 doses of 125 mg IV bolus undiluted for 10 min for patients in hemodialysis or 1-h infusion in 100 mL NS. | >20%: hypotension, vomiting, nausea, headache, diarrhea, injection site reaction, muscle cramps; 10-20%: dizziness, tachycardia, hypertension, dyspnea; 1-10%: chest pain, thrombosis, edema, pruritus, hyperkalemia, abdominal pain, pharyngitis, cough, fever; <1%: flushing, hypersensitivity reaction. | $610.40 (1000 mg Ferrlecit) | 1-wk interval recommended before MRI. |
| Ferumoxytol | Not recommended | 1020 mg per treatment; 2 doses of 510 mg, >15 min infusion in 50-250 mL NS or 5% dextrose, 3-8 d apart or single 1020-mg dose, 30-min infusion; Observation for 30 min after infusion recommended. | 1-10%: hypotension, edema, chest pain, hypertension, dizziness, headache, pruritus, rash, diarrhea, nausea, constipation, vomiting, abdominal pain, hypersensitivity reaction, cough, dyspnea, fever. | $2571.42 (1020 mg of Feraheme) | 12- (US) to 24- (Europe) wk interval recommended before MRI. |
| FCM | Not recommended | 1500 mg per treatment; 2 doses of 750 mg undiluted IV at 100 mg/min, or in 250 mL NS 15-min infused 7 d apart; Observation recommended for 30 min after infusion. | >10%: hypophosphatemia (<2 mg/dL); 1% to 10%: hypertension, hypotension, flushing, skin discoloration at injection site, nausea, vomiting, abdominal pain, increased ALT, dizziness, headache; <1%: abdominal pain, anaphylaxis, diarrhea, increased GGT, injection site reaction, paresthesia, skin rash, sneezing. | $2735.10 (1500 mg of Injectafer) | Verification of phosphate levels is recommended for repeated infusions; 1-wk interval recommended before MRI. |
| Ferric derisomaltose | Not recommended | 1000-mg single dose in 100-500 mL NS with a final concentration >1 mg iron/mL, infused over >20 min. | 1-10%: hypophosphatemia, skin rash, nausea; <1%: asthma, severe hypersensitivity reaction. | $2957.10 USD (1000 mg of Monoferric) | Previously iron isomaltoside; verification of phosphate levels is recommended for repeated infusions; 4-wk interval recommended before MRI. |
ALT, alanine transferase; AWP, average wholesale price (reported on UpToDate.com; last accessed 25 September 2020); GGT, γ-glutamyl transferase; LMW, low-molecular-weight; MRI, magnetic resonance imaging; NS, normal saline (0.9% sodium chloride); USD, US dollars.