What is the dose of elemental iron in 2 ampules of an intramuscular (IM) iron preparation?

Elemental Iron Content in 2 Ampules of IM Iron

Two ampules of intramuscular iron preparation (iron dextran/Cosmofer) contain 200 mg of elemental iron, with each ampule providing 100 mg of elemental iron. 1

Understanding IM Iron Preparations

Intramuscular iron is available in specific formulations designed for deep gluteal injection:

• Iron (III) hydroxide dextran (Cosmofer) is the primary IM iron preparation available, containing 100 mg elemental iron per ampule 1
• IM iron administration requires multiple injections to achieve therapeutic dosing 1
• Injections are typically painful and can cause tissue damage at the injection site 1

Limitations of Intramuscular Iron

Despite being available, IM iron has significant drawbacks:

• Current guidelines consider intramuscular iron largely obsolete due to:
  • Painful administration requiring deep gluteal injection 1
  • Potential for tissue damage at injection sites 1
  • Association with unacceptable side effects 1
• No clear clinical evidence demonstrates IM iron to be less toxic or more effective than oral or intravenous iron 1

Preferred Iron Replacement Options

Modern iron replacement therapy guidelines recommend:

• Oral iron therapy as first-line for mild iron deficiency anemia:

  • Standard dosing: 50-100 mg elemental iron once daily 1
  • Ferrous sulfate 200 mg twice daily provides 65 mg elemental iron per tablet 1
  • Treatment should continue for 3 months after iron deficiency correction 1

• Intravenous iron therapy is preferred when:

  • Oral iron is contraindicated, ineffective or not tolerated 1
  • Hemoglobin is below 10 g/dL 1
  • Rapid correction of iron deficit is required 2
  • Patient has clinically active inflammatory bowel disease 1

Clinical Considerations for Iron Therapy

When selecting iron replacement therapy:

• Consider patient-specific factors including severity of anemia, comorbidities, and tolerance 3
• Monitor hemoglobin response within the first 4 weeks of treatment 1
• Continue treatment for approximately 3 months after hemoglobin normalization 1
• Monitor blood counts periodically (every 6 months initially) after restoration of hemoglobin and iron stores 1

Important Cautions

• Intramuscular iron administration carries risks without clear benefits over other routes 1
• Modern intravenous iron formulations are generally safer and more effective than IM preparations 2, 4
• When using parenteral iron, facilities for managing anaphylaxis should be available 1