What is the dosing for intravenous (IV) iron infusion therapy?

From the Guidelines

Ferric carboxymaltose is the preferred intravenous iron preparation for most adult patients, with a typical dose of 750-1000 mg, considering the patient's weight and hemoglobin level, as well as potential risks such as hypophosphatemia 1. The dosing for ferric carboxymaltose can be administered as a single dose of 1000 mg or as two doses of 750 mg given one week apart, with the maximum recommended cumulative dose being 1000 mg iron per week 1. Some key points to consider when administering intravenous iron preparations include:

• Monitoring patients for hypersensitivity reactions, especially during the first infusion
• Informing patients of potential side effects, including headache, nausea, hypotension, or joint pain
• Administering iron infusions in a setting where anaphylaxis can be managed, with vital signs monitored during and after the infusion
• Considering the risk of hypophosphatemia associated with ferric carboxymaltose, particularly with repeated dosing 1. Other intravenous iron preparations, such as iron sucrose, ferumoxytol, and iron dextran, may also be used, but ferric carboxymaltose is generally preferred due to its convenience of dosing and efficacy 1. It is essential to note that the choice of intravenous iron preparation and dosing schedule should be individualized based on the patient's specific needs and medical history, and that the most recent and highest-quality evidence should be consulted to inform clinical decision-making 1.

From the FDA Drug Label

2 DOSAGE AND ADMINISTRATION

1. 1 Recommended Dosage Recommended Dosage for Treatment of Iron Deficiency Anemia For patients weighing 50 kg or more, the recommended dosage is: Injectafer 750 mg intravenously in two doses separated by at least 7 days for a total cumulative dose of 1,500 mg of iron per course In adult patients, Injectafer 15 mg/kg body weight up to a maximum of 1,000 mg intravenously may be administered as a single-dose per course.

• The recommended iron infusion dosing for patients weighing 50 kg or more is Injectafer 750 mg intravenously in two doses separated by at least 7 days for a total cumulative dose of 1,500 mg of iron per course.
• For adult patients, the recommended dosing is Injectafer 15 mg/kg body weight up to a maximum of 1,000 mg intravenously as a single-dose per course 2.
• The recommended iron infusion is Injectafer.

From the Research

Iron Infusion Dosing

• The dosing of iron infusion varies depending on the patient's iron deficit and the type of iron preparation used 3, 4, 5, 6, 7.
• Ferric carboxymaltose is an intravenous iron preparation that can be administered in a single high dose of up to 1000 mg of iron in 15 minutes or less 3, 4, 5, 6.
• The total iron concentration in the serum increases rapidly in a dose-dependent manner after intravenous administration of ferric carboxymaltose 3.
• Studies have shown that ferric carboxymaltose is effective in correcting iron-deficiency anemia and replenishing iron stores in various patient populations, including those with inflammatory bowel disease, heavy uterine bleeding, postpartum iron-deficiency anemia, and chronic kidney disease 3, 4, 5, 6.
• The efficacy of ferric carboxymaltose is similar to that of iron sucrose, and it is superior to oral iron or placebo in replenishing iron stores 5, 6.

Dosing Considerations

• The average iron deficit in patients with iron deficiency anemia is approximately 1500 mg, suggesting that a total cumulative dose of 1000 mg of intravenous iron may be insufficient for iron repletion in a majority of patients 7.
• A dose of 1500 mg of ferric carboxymaltose may be more effective in correcting iron deficiency anemia and reducing the need for retreatment with intravenous iron 7.
• The dosing of iron infusion should be individualized based on the patient's iron deficit and clinical response to treatment 3, 4, 5, 6, 7.

Types of Iron Preparations

• Ferric carboxymaltose is a macromolecular ferric hydroxide carbohydrate complex that allows for controlled delivery of iron to target tissues 3.
• Iron sucrose is another type of intravenous iron preparation that is commonly used to treat iron deficiency anemia 3, 4, 5, 6.
• Oral iron preparations, such as ferrous sulfate, are also available, but may be less effective than intravenous iron preparations in correcting iron deficiency anemia 3, 4, 5, 6.