Table 2.
FDA approved parenteral iron preparations in the US
| Iron concentration (mg/ml) |
Max approved dose (mg elemental) |
Vial volume (ml) |
Test dose | Premedication | Total dose infusion possible |
Route | |
|---|---|---|---|---|---|---|---|
| Iron dextran (high molecular weight) |
50 | 100* | 1-2 | Required γ | No | Yes | IM IV (preferred) |
| Iron dextran (low molecular weight) |
50 | 100* | 2 | Required γ | No | Yes | IM IV (preferred) |
| Ferric gluconate | 12.5 | 125• | 5 | Not required |
No | No | IV only |
| Iron sucrose | 20 | 200ε | 5 | Not required |
No | No | IV only |
| Iron Polyglucose sorbitol carboxymethylether |
30 | 510 κ | 17 | Not required |
No | No | IV only |
The formula used for calculation of parenteral iron dose: Required iron dose (mg) = (2.4 × (target Hb-actual Hb) × pre-pregnancy weight (kg)) + 1000 mg for replenishment of stores (81)
Doses ≤ 300 mg, slow iv push up to 50 mg/minute; or diluted in 100-250 ml normal saline. For total dose infusion, the dose should be diluted to normal saline (250-1000 ml) and after a test dose, the solution can be infused over 4-6 hours.
25 mg over 5 minutes. Observe patient for 1 hour.
IV infusion of 125 mg diluted in 100 ml normal saline over 60 minutes daily for 5 doses maximum per week, up to a cumulative dose of 1 gram. Transferrin saturation and serum iron levels should be checked 48 hours after the third dose to assist to detect iron accumulation. No need for daily infusions if the transferrin saturation is more than 40%.
100mg IVP over 2-5 minutes; 100 mg/ 100ml normal saline over 15 minutes; 200mg / 250ml normal saline over 2 - 4 hours for a total dose of 1,000mg over a 14-day period. If more than 600mg is needed for iron repletion, a transferrin saturation and serum iron levels should be checked 72 hours after the completion of weekly dose to assist in detection of iron accumulation. May stop infusions unless transferrin saturation is less than 40%
5-10 mg IV push
ref: Adamson JW. Iron deficiency and other hypoproliferative anemias. In: Braunwald E, Fauci AS, Kasper DL, editors. Harrison's textbook of internal medicine. 17th ed. New York: McGraw Hill; 2008. pp. 628–33.