From the Guidelines
Iron infusions are contraindicated in patients with known hypersensitivity to iron products, active infections, and iron overload conditions such as hemochromatosis. Precautions should be taken with patients who have a history of allergic reactions, asthma, eczema, or other atopic allergies as they may have increased risk of hypersensitivity reactions 1. According to the most recent guidelines, true anaphylaxis to intravenous iron is very rare, and the vast majority of reactions are complement activation–related pseudo-allergy (infusion reactions) 1.
Key Considerations
- Patients with a history of allergic reactions should be closely monitored during iron infusion administration 1
- Facilities administering iron infusions should have resuscitation equipment and medications readily available to manage potential anaphylactic reactions 1
- Different iron formulations have varying safety profiles, with iron dextran carrying a higher risk of serious adverse reactions 1
- Iron infusions should not be given to patients with active infections, and concomitant administration of i.v. iron and cardiotoxic chemotherapy should be avoided 1
Administration Guidelines
- Healthcare providers should perform iron studies to confirm iron deficiency and determine appropriate dosing before administering iron infusions 1
- Patients should be observed closely for symptoms of hypersensitivity reactions for at least 30 minutes following each i.v. iron administration 1
- Intravenous iron formulations have similar risks, and true anaphylaxis is very rare 1, but precautions should still be taken to minimize the risk of adverse reactions.
From the FDA Drug Label
CONTRAINDICATIONS Hypersensitivity to the product. All anemias not associated with iron deficiency. PRECAUTIONS General: Unwarranted therapy with parenteral iron will cause excess storage of iron with the consequent possibility of exogenous hemosiderosis. Anaphylaxis and other hypersensitivity reactions have been reported after uneventful test doses as well as therapeutic doses of iron dextran injection.
The contraindications for iron infusion are:
- Hypersensitivity to the product
- All anemias not associated with iron deficiency The precautions for iron infusion include:
- Risk of excess iron storage and exogenous hemosiderosis with unwarranted therapy
- Hypersensitivity reactions, including anaphylaxis
- Use with caution in individuals with histories of significant allergies and/or asthma 2 2
From the Research
Contraindications for Iron Infusion
- Early pregnancy is a contraindication to iron infusions 3
- Haemochromatosis, a condition characterized by excessive iron absorption, is also a contraindication for iron infusions, as it can lead to liver and other organ toxicity 4
Precautions for Iron Infusion
- A previous reaction to an iron infusion is a major risk factor for hypersensitivity reactions 3
- A fast iron infusion rate, multiple drug allergies, severe atopy, and possibly systemic inflammatory diseases are also risk factors for hypersensitivity reactions 3
- Old age and serious co-morbidity may worsen the impact of acute reactions if they occur 3
- Patients with a history of infusion reaction should be managed with caution, and readministration of the same formulation may be associated with a higher reaction rate 5
Special Considerations
- Iron infusions should be administered with meticulous observation, and medical and nursing staff should be well-trained to recognize and manage adverse reactions 3
- The use of premedication and test doses is not necessary for most patients, but may be considered for those with a history of infusion reaction 5