What to do if a patient develops a full body rash after the first dose of Feraheme (ferumoxytol)?

Management of Full Body Rash After First Dose of Feraheme

Stop the infusion immediately, provide aggressive symptomatic treatment with antihistamines and corticosteroids, and permanently discontinue Feraheme due to this serious hypersensitivity reaction. 1

Immediate Actions

Stop Administration

• Discontinue the infusion immediately upon recognition of a full body rash, as this represents a hypersensitivity reaction that can progress to life-threatening anaphylaxis 1
• Serious allergic reactions to Feraheme can occur after the first dose and may lead to death 1

Assess Severity

• Evaluate for additional signs of severe hypersensitivity including: 1
  • Itching or pruritus
  • Dizziness or lightheadedness
  • Swelling of tongue or throat
  • Wheezing or breathing problems
  • Hypotension
• A full body rash indicates a systemic reaction requiring aggressive management 1

Acute Treatment Protocol

Symptomatic Management

• Administer antihistamines immediately (diphenhydramine 25-50 mg IV or equivalent) 2
• Give corticosteroids (methylprednisolone 100 mg IV or equivalent) for aggressive symptomatic control 2
• Provide additional supportive care as needed for associated symptoms (hypotension, bronchospasm) 2

Monitoring Requirements

• Observe the patient for at least 30 minutes after symptom resolution, as reactions can recur or progress 1
• Monitor vital signs continuously during the acute phase 2
• Watch for delayed reactions, as hypersensitivity can manifest hours after administration 1

Future Management Decisions

Permanent Discontinuation

• Do not rechallenge with Feraheme - patients who develop full body rash should permanently discontinue this medication 1
• The FDA label explicitly warns that serious allergic reactions can occur with subsequent doses even in patients who tolerated initial doses 1
• Document this as a drug allergy in the patient's medical record 1

Alternative Iron Therapy

• Consider alternative parenteral iron formulations (iron sucrose, ferric gluconate, ferric carboxymaltose, iron isomaltoside) for future iron replacement 3, 4
• Note that patients with history of allergies to multiple medications have increased risk of reactions to parenteral iron products 1
• Oral iron therapy may be reconsidered if the indication for parenteral iron was intolerance rather than malabsorption 1

Critical Pitfalls to Avoid

• Do not attempt to restart the infusion at a slower rate - unlike mild infusion reactions (Grade 1/2) where slowing may be appropriate, a full body rash represents a more severe systemic reaction requiring permanent discontinuation 2
• Do not delay treatment - hypersensitivity reactions can rapidly progress to anaphylaxis with cardiovascular collapse 1
• Do not assume the reaction will be mild - rechallenging patients who have had urticarial or erythematous eruptions can be very dangerous 5
• Avoid using corticosteroids alone without antihistamines - combination therapy provides optimal symptom control for hypersensitivity reactions 2