What is a recommended IV (intravenous) iron regimen for the treatment of iron deficiency anemia?

From the Guidelines

Intravenous iron formulations that can replace iron deficits with 1 or 2 infusions are preferred for the treatment of iron deficiency anemia. The choice of IV iron regimen depends on several factors, including the severity of anemia, urgency of treatment, venous access, cost considerations, and local availability 1. Some recommended IV iron regimens include:

• Iron sucrose (Venofer) administered as 200 mg IV infusions given 2-3 times weekly for a total of 1000 mg
• Ferric carboxymaltose (Ferinject/Injectafer) given as 750-1000 mg per dose with a second dose after 7 days if needed
• Iron dextran (INFeD, CosmoFer) can be administered as a single total dose infusion of 1000-1500 mg but requires a test dose due to higher risk of hypersensitivity reactions
• Iron isomaltoside (Monofer) can be given as a single infusion of up to 20 mg/kg These regimens should be adjusted based on the patient's weight and hemoglobin level 1. IV iron is indicated when oral iron is ineffective, not tolerated, or when rapid repletion is needed, and treatment success can be assessed by measuring hemoglobin levels 2-4 weeks after completion of the regimen 1. It is also important to monitor patients for infusion reactions and have resuscitation equipment available, as infusion reactions can occur, although anaphylaxis due to IV iron is exceedingly rare 1. The total intravenous iron cumulative doses should be calculated on the basis of formulas of the deficit of body iron, allowing for the correction of the Hb deficit and rebuilding the iron stores, and serum ferritin levels should be monitored to avoid toxicity of iron overload 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. For patients weighing less than 50 kg, the recommended dosage is Injectafer 15 mg/kg body weight intravenously in two doses separated by at least 7 days per course

The recommended IV iron regimen for the treatment of iron deficiency anemia is:

• For patients weighing 50 kg or more: 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: 15 mg/kg body weight up to a maximum of 1,000 mg intravenously may be administered as a single-dose per course.
• For patients weighing less than 50 kg: 15 mg/kg body weight intravenously in two doses separated by at least 7 days per course 2.

Alternatively, for iron dextran (IV), the total amount of INFeD required for the treatment of iron deficiency anemia or iron replacement for blood loss is determined from the table or appropriate formula, with a recommended dose of 0.0442 (Desired Hb - Observed Hb) x LBW + (0.26 x LBW) 3.

From the Research

IV Iron Regimen for Iron Deficiency Anemia

• The recommended IV iron regimen for the treatment of iron deficiency anemia varies depending on the patient's iron deficit and medical history 4, 5.
• A study published in 2015 found that a total cumulative dose of 1000 mg of IV iron may be insufficient for iron repletion in a majority of patients with iron deficiency anemia, and a dose of 1500 mg is closer to the actual iron deficit in these patients 4.
• Ferric carboxymaltose is a novel iron complex that allows for controlled delivery of iron to target tissues and is effective in the treatment of iron-deficiency anemia, delivering a replenishment dose of up to 1000 mg of iron during a minimum administration time of ≤15 minutes 5.
• The administration of ferric carboxymaltose can be repeated weekly, and it is well tolerated in clinical trials, with most drug-related adverse events considered to be mild to moderate in severity 5.
• Other IV iron formulations, such as iron sucrose and iron gluconate, are also effective and safe for use in primary care clinics, with a low risk of adverse effects 6.

Dosage and Administration

• The dosage of IV iron can vary depending on the patient's iron deficit and medical history, but a common dosage is 1000 mg of iron sucrose or ferric carboxymaltose administered over ≤15 minutes 5, 6.
• The administration of IV iron can be repeated weekly, and the frequency of the infusion treatments depends on the underlying disease and ranges from three times a week to once a month 6.
• A desensitization protocol can be used for patients with a history of hypersensitivity reactions to IV iron, and ferric carboxymaltose can be administered safely in these patients using an eleven-step desensitization protocol 7.

Efficacy and Safety

• IV iron therapy is effective and safe for the management of iron deficiency anemia, with significant improvements in hemoglobin and serum ferritin levels compared to oral iron supplements 8.
• The adverse effect profile of IV iron therapy is generally mild, with common side effects including arthralgia, hypotension, and metallic taste 6, 8.
• Anaphylaxis is a rare but potentially life-threatening side effect of IV iron therapy, and patients should be closely monitored during administration 6, 8.