From the Guidelines
The recommended dosage for intravenous (IV) iron infusion is 1000 mg of ferric carboxymaltose (FCM) administered in a single infusion over 15-30 minutes, as it has been shown to be safe and efficacious in various conditions associated with iron deficiency 1. When considering IV iron formulations, those that can replace iron deficits with 1 or 2 infusions are preferred over those that require more than 2 infusions, as stated in the AGA clinical practice update on management of iron deficiency anemia 1. Some key points to consider when administering IV iron infusions include:
- Confirming iron deficiency through blood tests measuring ferritin, transferrin saturation, and hemoglobin levels
- Administering the infusion in a clinical setting where patients can be monitored for potential allergic reactions
- Being aware of potential side effects, such as temporary discoloration at the injection site, headache, nausea, or joint pain
- Considering the specific iron preparation, patient's weight, hemoglobin level, and iron deficiency severity when determining the dosage It's also important to note that ferric carboxymaltose (FCM) should be diluted in 100 mL of normal saline and infused over 20-30 minutes, with precautions to observe for acute onset of minor infusion reactions 1. In certain cases, such as chronic heart failure, single doses of ferric carboxymaltose (500-1000 mg iron) may be considered to correct iron deficiency, but only if hemoglobin levels are below 15 g/dL 1.
From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION
- 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 dosage for intravenous (IV) iron infusion with ferric carboxymaltose (IV) 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, or 15 mg/kg body weight up to a maximum of 1,000 mg intravenously 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
From the Research
Recommended Dosage for Intravenous (IV) Iron Infusion
The recommended dosage for intravenous (IV) iron infusion can vary depending on the specific iron preparation and the patient's individual needs.
- Ferric carboxymaltose can be administered in a single dose of up to 1000 mg of iron over a period of 15 minutes or less 3.
- The total iron concentration in the serum increases rapidly in a dose-dependent manner after intravenous administration of ferric carboxymaltose 3.
- A study suggests 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 may be more effective 4.
- Ferric carboxymaltose can be given at high doses (20 mg/kg, up to 1000 mg) over a short period (≤ 15 min), without test dosing 5.
- A single high dose of ferric carboxymaltose (up to 750 mg of iron in the US and 1,000 mg of iron in the EU) can be infused in a short time frame (15 min) 6.
Factors Influencing Dosage
Several factors can influence the dosage of IV iron infusion, including:
- The patient's weight and iron deficit 4
- The specific iron preparation being used 3, 5, 6
- The patient's medical condition and underlying disease 3, 5, 6
- The presence of any adverse reactions or hypersensitivity to the iron preparation 3, 6
Administration Considerations
IV iron infusions should be administered by a healthcare professional in a clinical setting, with appropriate monitoring and support available in case of any adverse reactions 3, 5, 6.