Contraindications for Iron Supplementation
Iron supplementation is contraindicated in patients with iron overload conditions such as hemochromatosis, and should not be given when ferritin levels are normal or elevated as it can be potentially harmful. 1
Absolute Contraindications
- Hemochromatosis and other iron overload disorders - Iron supplementation would exacerbate the condition and increase risk of tissue damage to liver, heart, and pancreas 1, 2
- Normal or elevated ferritin levels - Iron supplementation in the presence of normal or high ferritin values is not recommended and potentially harmful 1
- Pregnancy - All iron chelation drugs are contraindicated in pregnancy 1
- Renal failure - Dose adjustment is required in renal failure for iron chelation drugs 1
Relative Contraindications/Precautions
- Active infection - Iron supplementation is not recommended for patients with active infection as iron may promote bacterial growth 1
- During periods of neutropenia - IV iron should be avoided as infused iron may be used by microorganisms 1
- Concurrent administration with certain antibiotics - Oral iron products interfere with absorption of certain antibiotics and should not be taken within two hours of each other 3
- Same-day administration with anthracyclines - IV iron should not be administered on the same day as anthracyclines due to theoretical risk that iron may potentiate cardiotoxicity 1
Special Considerations
- Inflammatory conditions - Iron parameters can be misleading in the presence of inflammation, requiring careful assessment before supplementation 1
- Anemia of chronic disease - Functional iron deficiency in inflammatory conditions may require different approaches to iron supplementation 1
- Gastrointestinal side effects - Oral iron can cause nausea, constipation, or diarrhea, which may limit tolerability 1, 3
Monitoring Requirements
- Ferritin levels - Should be monitored to prevent iron overload; target levels during maintenance therapy should be 50-100 μg/L 1
- Liver and renal function - For patients on iron chelators like deferasirox (DFX), liver and renal function should be monitored monthly 1
- Audiological and ophthalmological review - Should be performed prior to starting iron chelation treatment and annually thereafter 1
Safety Warnings
- Accidental overdose risk - Iron-containing products are a leading cause of fatal poisoning in children under 6 and should be kept out of reach 3
- Infusion reactions - IV iron can cause reactions that may rarely be life-threatening (though very infrequent with newer formulations at <1:250,000 administrations) 1
- High molecular weight iron dextran - Associated with increased risk of anaphylactic reactions compared to other iron preparations and should be avoided 1
When considering iron supplementation, careful assessment of iron status using appropriate biomarkers (ferritin, transferrin saturation) is essential to avoid inappropriate supplementation in patients who don't need it or for whom it could be harmful 1.