Monoferric (Ferric Derisomaltose) Dosing for Iron Deficiency Anemia
Ferric derisomaltose (Monoferric) is the only IV iron formulation with FDA approval for total dose infusion, allowing for complete iron repletion in a single administration for patients with iron deficiency anemia. 1
Dosing Recommendations
- For patients weighing ≥50 kg with hemoglobin >10 g/dL: administer 1000 mg as a single dose 2
- For patients weighing ≥50 kg with hemoglobin ≤10 g/dL: administer 1500 mg as a single dose 2
- For patients weighing <50 kg with hemoglobin >10 g/dL: administer 500 mg as a single dose 2
- For patients weighing <50 kg with hemoglobin ≤10 g/dL: administer 1000 mg as a single dose 2
Administration Method
- Administer as an intravenous infusion over at least 20 minutes for doses ≤1000 mg 2
- For doses >1000 mg, administer over 30 minutes or more 2
- No test dose is required (unlike with iron dextran preparations) 2
Advantages of Ferric Derisomaltose
- Allows for higher cumulative dosing in fewer administrations compared to other IV iron formulations 3
- Demonstrates faster and greater improvements in hemoglobin and other biochemical efficacy parameters compared to iron sucrose 3
- Associated with fewer cardiovascular adverse events compared to iron sucrose in patients with chronic kidney disease 4
- Shows significantly lower risk of hypophosphatemia compared to ferric carboxymaltose 5, 6
- May improve quality of life and decrease cardiovascular events in patients with heart failure and iron deficiency anemia 7
Monitoring and Follow-up
- Check ferritin and transferrin saturation at next scheduled visit, preferably after 3 months 2
- Do not evaluate iron parameters within the first 4 weeks after administration as ferritin levels are markedly elevated immediately following IV iron administration 1, 8
- Monitor for recurrent iron deficiency every 3 months for at least a year after correction, and between 6 and 12 months thereafter 2
- Re-treatment with IV iron should be initiated as soon as serum ferritin drops below 100 μg/L or hemoglobin below 12 g/dL (women) or 13 g/dL (men) 2
Special Considerations
- In patients with heart failure, iron deficiency is diagnosed when serum ferritin <100 μg/L, or serum ferritin 100-299 μg/L with transferrin saturation <20% 8
- Do not administer IV iron if hemoglobin >15 g/dL 2
- For patients with chronic kidney disease, dosing is based on body weight (20 mg/kg) 2
- In patients with inflammatory bowel disease, aim for post-treatment serum ferritin levels of up to 400 μg/L to prevent recurrence of iron deficiency 2