From the Research
A seizure induced by an iron infusion is generally considered a contraindication to future intravenous (IV) iron infusions. If a patient has experienced a seizure during or after an iron infusion, alternative methods of iron supplementation should be considered. Oral iron supplements are typically the first alternative, though they may be less effective in certain conditions like inflammatory bowel disease or after gastric bypass surgery. In cases where IV iron is deemed medically necessary despite a previous seizure, extreme caution should be exercised with consideration of different iron formulations (such as iron sucrose, ferric carboxymaltose, or ferumoxytol), premedication with antihistamines and corticosteroids, slower infusion rates, and close monitoring in a controlled setting with resuscitation capabilities.
The mechanism behind iron-induced seizures likely involves hypersensitivity reactions, direct neurotoxicity from free iron, or rapid changes in serum iron levels affecting neuronal excitability, as suggested by studies on infusion reactions 1, 2. The risk of recurrent seizures with subsequent infusions is significant, and the potential benefits of IV iron must be carefully weighed against this serious risk in consultation with neurology and hematology specialists. According to a recent study, recommencement of the index infusion or subsequent rechallenge following an infusion reaction can be safe under certain conditions, but this does not necessarily apply to seizures 3.
Key considerations include:
- The type of iron formulation used, with some formulations potentially having a lower risk of adverse events than others 2
- The use of premedication and its potential to increase the risk of adverse events 2
- The importance of close monitoring and having resuscitation capabilities available during infusion 1, 3
- The need for individualized assessment and management of patients with a history of infusion reactions, including seizures 3
Ultimately, the decision to proceed with future IV iron infusions after a seizure should be made on a case-by-case basis, taking into account the latest evidence and guidelines, as well as the individual patient's risk-benefit profile 4, 5.