Iron Dextran Dosing for Severe Iron Deficiency Anemia
For severe iron deficiency anemia, iron dextran should be administered as a weekly regimen of 100 mg IV over 5 minutes for 10 doses to achieve a total dose of 1 gram, or as a total dose infusion given over several hours. 1
Administration Protocol
Initial Test Dose
- Prior to initiating IV iron dextran therapy, a one-time test dose of 25 mg should be given IV and patient observed for 1 hour before administering the main dose 2, 1
- For pediatric patients weighing <10 kg, the test dose should be 10 mg; for those weighing 10-20 kg, the test dose should be 15 mg 2
- Iron dextran should be administered by slow IV push at a rate not exceeding 1.0 mL (50 mg, if undiluted) per minute 2
Dosing Options
- Option 1: Weekly dosing regimen - 100 mg IV over 5 minutes once weekly for 10 doses to achieve a total dose of 1 gram 1
- Option 2: Total dose infusion - Single doses of 500-1000 mg diluted in 250 mL normal saline infused over 1 hour 1, 3
- For patients with chronic kidney disease on home hemodialysis or peritoneal dialysis, single doses of 500-1000 mg can be administered 1
Monitoring Parameters
- Monitor iron status by measuring transferrin saturation (TSAT) and serum ferritin at least once every 3 months 2, 1
- Target iron parameters: TSAT ≥20% and serum ferritin ≥100 ng/mL 2, 1
- Avoid measuring iron parameters within 7-14 days after IV iron administration for accurate results 1
- The goal of iron therapy is to improve erythropoiesis, not just to attain specific levels of TSAT and/or serum ferritin 2
Safety Considerations
- Acute adverse reactions may occur with administration of IV iron dextran, including anaphylaxis-like reactions in fewer than 1% of administrations 2
- Common adverse events include hypotension, hypertension, nausea, vomiting, diarrhea, pain, fever, dyspnea, pruritus, headaches, and dizziness 1
- A history of multiple drug allergies is associated with increased risk of an acute iron dextran reaction 2
- Have emergency medications (epinephrine, diphenhydramine, corticosteroids) readily available during administration 2, 4
Special Considerations
- For patients who cannot tolerate oral iron due to gastrointestinal symptoms or inadequate response, IV iron dextran is an effective alternative 5
- Research shows that 500 mg/week for 2 weeks can be as effective and safe as 200 mg/week for 5 weeks, and more cost-effective 3
- Response to therapy is typically faster in patients who have been severely anemic for prolonged periods 6
- Avoid iron administration in patients with active infection 1
- To prevent iron overload, temporarily withhold IV iron if TSAT exceeds 50% or serum ferritin exceeds 800 ng/mL 2, 7