| In whom and when? |
Indications
Intravenous iron, ferric carboxymaltose, should be considered in symptomatic patients with chronic systolic HFrEF or heart failure with LVEF < 45% and iron deficiency (2016 ESC guideline recommendations: Class of Recommendation IIa, Level of Evidence A). Iron deficiency can be diagnosed based on the following thresholds: serum ferritin <100 μg/L or TSAT < 20% (if serum ferritin 100–300 μg/L, a TSAT test will be required to diagnose iron deficiency).
|
Contraindications
Hypersensitivity to the active substance, ferric carboxymaltose, or any of its excipients. Known serious hypersensitivity to other parenteral iron products. Anaemia not attributed to iron deficiency, e.g. other microcytic anaemia. Evidence of iron overload or disturbances in the utilization of iron.
|
Cautions/seek specialist advice
Use with caution in patients with acute or chronic infection; treatment with ferric carboxymaltose should be stopped in patients with ongoing bacteraemia. Patients with known drug allergies, including those with a history of severe asthma, eczema, or other atopic allergies, may be at increased risk of hypersensitivity reaction. Increased risk of hypersensitivity reactions to parenteral iron complexes in patients with immune or inflammatory conditions (e.g. systemic lupus erythematosus and rheumatoid arthritis). No clinical evidence for ferric carboxymaltose in patients with HFpEF (LVEF > 50%) or LVEF > 45%. Ferric carboxymaltose has not been evaluated in patients with Hb level >15 g/dL.
|
| Where? |
Ferric carboxymaltose can be administered in the hospital or community setting, where staff are trained and equipped to monitor and manage hypersensitivity reactions.
|
| How to use? |
Determination of the initial iron need is calculated based on body weight and Hb levels (see dosing table in Figure
1
B). Ferric carboxymaltose may be given intravenously as an undiluted bolus injection or an infusion that requires dilution. If given as an infusion, it should not be overdiluted (see dilution plan in Table
4). The maximum recommended cumulative dose of ferric carboxymaltose is 1000 mg of iron (i.e. 20 mL ferric carboxymaltose)/week.
|
| Monitoring |
Following replacement, iron status should be re‐evaluated in 12 weeks and further iron repletion provided as needed, as well as evaluation for blood loss as indicated. Iron status should also be rechecked if patients remain symptomatic despite receiving optimal background heart failure medications, or in the event of Hb levels decreasing. In patients with stable CHF, iron status should be checked as part of the routine laboratory test assessments (at least once a year).
|
