Ferric Carboxymaltose Dilution Guidelines
No, diluting 1 gram of Ferric Carboxymaltose (FCM) in 500ml Normal Saline is not the correct dilution. According to current guidelines, 1 gram of FCM should be diluted in a maximum of 250ml of normal saline, not 500ml 1, 2.
Correct Dilution Protocol for FCM
The proper dilution guidelines for FCM administration are clearly established:
| Iron Dose | FCM Volume | Maximum Sodium Chloride Solution | Minimum Administration Time |
|---|---|---|---|
| 500 mg | 10 mL | 100 mL | 6 minutes |
| 1000 mg | 20 mL | 250 mL | 15 minutes |
These dilution parameters are specifically outlined in the 2024 expert consensus guidelines from the American Journal of Hematology 1 and the European Society of Cardiology guidelines 1, 2.
Administration Considerations
- FCM should be infused over 15-30 minutes when given as a 1000 mg dose 1
- Over-dilution should be avoided as it may affect the stability of the iron complex 1
- The maximum recommended cumulative dose is 1000 mg iron per week 2
- FCM can alternatively be administered as an undiluted slow bolus injection at a rate of 100 mg/min 2, though this is less common in practice
Safety Considerations
- Patients must be observed for adverse effects for at least 30 minutes following each IV injection 1, 2
- Administration should occur in settings where staff are trained to monitor for and manage potential hypersensitivity reactions 2
- Common adverse effects (1-10% frequency) include dizziness, headache, hypertension, hypophosphatemia, injection-site reactions, and nausea 2, 3
- If paravenous leakage occurs during administration, the infusion must be stopped immediately to prevent skin staining/discoloration 1, 2
Clinical Implications of Proper Dilution
Using the correct dilution is important for:
- Safety: Proper dilution helps minimize infusion reactions
- Efficacy: Ensures optimal delivery of iron to target tissues
- Administration time: The recommended 15-minute infusion time for 1000 mg is based on the proper dilution in 250 mL NS
Bottom Line
When administering 1 gram of FCM, dilute it in 250 mL of normal saline (not 500 mL) and infuse over 15 minutes. This ensures both safety and efficacy while following established clinical guidelines.