Recommended Use of Monofer (Ferric Derisomaltose) for Iron Deficiency Anemia
Monofer (ferric derisomaltose) should be administered intravenously when oral iron is contraindicated, ineffective, or not tolerated for treating iron deficiency anemia. 1
Indications for Ferric Derisomaltose
- Intravenous ferric derisomaltose is indicated in patients with:
- Intolerance to oral iron therapy 1, 2
- Inadequate response to oral iron therapy 1, 2
- Need for rapid iron repletion 2
- Hemoglobin below 10 g/dL 2
- Active inflammatory bowel disease with compromised absorption 1, 2
- Chronic kidney disease with iron deficiency anemia 2, 3
- Post-bariatric surgery with disrupted duodenal iron absorption 1
Dosing Guidelines
- Dosing should be based on body weight and hemoglobin level: 2
- For patients <70 kg with Hb 10-12 g/dL (women) or 10-13 g/dL (men): 1000 mg
- For patients ≥70 kg with Hb 10-12 g/dL (women) or 10-13 g/dL (men): 1500 mg
- For patients with Hb 7-10 g/dL: 2000 mg
Administration Method
- Administer as an intravenous infusion over 15-30 minutes 2
- No test dose is required before administration, unlike with iron dextran preparations 2
- Resuscitation facilities should be available during administration due to small risk of hypersensitivity reactions 2, 4
- Avoid administering on the same day as anthracyclines in cancer patients due to theoretical risk of potentiating cardiotoxicity 1
Safety Profile
- Ferric derisomaltose has a favorable safety profile with adverse drug reactions observed in approximately 10.5% of patients 3
- Hypersensitivity reactions are rare but can occur (incidence of 0.4% in real-world data) 5
- Anaphylactic reactions are very rare (<0.1%) 5
- Contraindications include: 2
- Hypersensitivity to the active substance or excipients
- Known serious hypersensitivity to other parenteral iron products
- Anemia not attributed to iron deficiency
- Evidence of iron overload or disturbances in iron utilization
Advantages Over Other IV Iron Formulations
- Allows for high-dose single infusion, reducing the need for multiple visits 2, 6
- Associated with lower risk of hypophosphatemia compared to ferric carboxymaltose 6
- Real-world data shows statistically significant increases in hemoglobin and ferritin after treatment 5
Monitoring and Follow-up
- Monitor hemoglobin concentration and red cell indices at 3-month intervals for the first year after iron repletion 2
- Re-evaluate iron status 3 months after treatment, as ferritin levels are markedly increased immediately following IV iron administration 2
- After restoration of hemoglobin and iron stores, monitor blood count periodically (perhaps every 6 months initially) to detect recurrent iron deficiency anemia 1
Efficacy in Specific Populations
- In non-dialysis-dependent chronic kidney disease patients, ferric derisomaltose has shown superior efficacy compared to oral iron for increasing hemoglobin 3
- More pronounced hemoglobin response is observed with doses ≥1000 mg 3
- Particularly effective in hospital specialties where operative blood loss is expected (surgery/obstetrics) 5
By following these guidelines for the use of ferric derisomaltose, clinicians can effectively treat iron deficiency anemia while minimizing risks and optimizing patient outcomes.