Table 1.
Pharmacologic characteristics of the main intravenous iron complexes
| Sodium ferric gluconate complexa | Iron sucroseb | High molecular weight iron dextranc | Low molecular weight iron dextrand | Ferric carboxymaltosee | Ferumoxytolf | Isomaltoside 1,000g | |
|---|---|---|---|---|---|---|---|
| Trade name | Ferrlicit® | Venofer® | Dexferrum® | Cosmoser® INFeD® |
Ferinject® | FeraHeme® | Monofer® |
| Carbohydrate shell | Gluconate | Sucrose | Dextran (branched polysaccharide) | Dextran (branched polysaccharide) | Carboxymaltose (branched polysaccharide) | Polyglucose sorbitol carboxymethylether | Isomaltoside 1,000 (linear oligosaccharide) |
| Molecular weight (Da)# | 37,500 | 34,000–60,000 | 265,000 | 165,000 | 150,000 | 750,000 | 150,000 |
| Classificationh | Type III | Type II | Type I | Type I | Type I | Type I | Type I |
| Iron content (mg/mL) | 12.5 | 20 | 50 | 50 | 50 | 30 | 100 |
| Half-life (hours) | 1 | 6 | 9–87 | 5–20 | 7–12 | 15 | 20 |
| Maximum single dose (mg) | 125 | 200 | 20 mg/kg | 20 mg/kg | 15 mg/kg (max 1,000 mg)* | 510 | 20 mg/kg |
| Reactivity with transferrin | High | Medium | Low | Low | Low | Low | Low |
| Test dose required## | No | No | Yes | Yes | No | No | No |
Notes:
Ferrlecit® prescribing information. Sanofi Aventis, Inc Bridgewater, NJ, USA.
Venofer® prescribing information. Vifor Pharma Ltd Glattbrugg, Switzerland.
Dexferrum® INFeD® prescribing information, Pharma, Morristown, NJ, USA.
Cosmofer® prescribing information, Pharmacosmos A/S, Holbæk, Denmark.
Ferinject® Injectafer® prescribing information. Vifor Pharma Ltd Glattbrugg, Switzerland.
Feraheme® prescribing information. AMAG Pharmaceuticals, Inc Waltham, MA, USA.
Monofer® prescribing information. Pharmacosmos A/S, Holbæk, Denmark.
Type I complexes are robust and strong and thus release only minimal amounts of ionic iron in the blood stream. Type II complexes are semi-robust and moderately strong and consequently less stable than Type I complexes. Type III complexes are the least stable and therefore release relatively large amounts of ionic iron into the blood stream. Type IV complexes are mixed complexes. They are heterogeneous mixtures, which may induce side effects such as allergic responses and saturation of the iron transport system.22
The molecular weight in this table are those given by the manufacturer, but since they are measured with different standards the values are not totally comparable.
This is only the case in USA. In Europe, the test dose has been removed for all iv iron products.
for infusion the maximal iron dose is 20 mg/mL.