How is Encicarb (iron carbonyl) injection administered?

Administration of Intravenous Iron Preparations

Note: The term "Encicarb" does not appear in standard medical literature or FDA-approved iron formulations. If you are referring to ferric carboxymaltose (FCM), iron sucrose, iron dextran, or another IV iron preparation, the following guidelines apply to the most commonly used intravenous iron products.

Administration Methods by Formulation Type

Ferric Carboxymaltose (FCM)

FCM can be administered as either an undiluted slow IV bolus injection at 100 mg/min (15 minutes for a 1000 mg dose) or as an infusion, making it highly convenient for clinical practice. 1

• Bolus injection: Administer undiluted at a rate of 100 mg/min 1
• Infusion method:
  • 500 mg dose: dilute 10 mL FCM in maximum 100 mL of sterile 0.9% sodium chloride, infuse over minimum 6 minutes 1
  • 1000 mg dose: dilute 20 mL FCM in maximum 250 mL of sterile 0.9% sodium chloride, infuse over minimum 15 minutes 1
• Maximum weekly dose: 1000 mg iron (20 mL FCM) per week 1
• Critical: Do not over-dilute FCM as this affects drug stability 1

Iron Sucrose

• Maximum single dose: 200 mg 2
• Maximum weekly dose: 500 mg 2
• Bolus administration: 200 mg over 10 minutes is licensed and more convenient than 2-hour infusion 2
• Infusion method for higher doses: For 300-500 mg doses, dilute in maximum 250 mL of 0.9% NaCl 2
• No test dose required, but consider for patients with history of sensitivities to IV iron or multiple drug allergies 2

Iron Dextran

• Hemodialysis patients: Maximum 100 mg per dose given as IV push over 2 minutes to minimize dose-related arthralgias/myalgias 1
• Non-dialysis CKD/peritoneal dialysis patients: Single doses of 500-1000 mg diluted in 250 mL normal saline, infused over 1 hour 1
• Premedication protocol (for higher doses): Diphenhydramine, cimetidine, and dexamethasone may reduce reactions 3

Ferric Sodium Gluconate

• Standard dosing: 62.5-125 mg mixed in 50-100 mL saline, infused over 30-60 minutes 1
• Maximum recommended: Do not exceed 125 mg as bolus or infusion per manufacturer guidelines 1

Dosing Calculations

Calculate initial iron need based on body weight and hemoglobin levels, NOT ferritin or transferrin saturation levels. 1

• Average iron deficit: Approximately 1400-1500 mg for most patients with iron deficiency anemia 4
• Common pitfall: A cumulative dose of 1000 mg may be insufficient for complete iron repletion in majority of patients; 1500 mg is closer to actual deficit 4

Safety Monitoring Requirements

During Administration

• Observe patients for minimum 30 minutes following each IV injection for hypersensitivity reactions 1
• Monitor vital signs during and after infusion 2
• Administer only where staff are trained and equipped to manage anaphylactic/anaphylactoid reactions 1
• Resuscitation facilities must be immediately available 1, 2

Managing Minor Infusion Reactions

Stop the infusion, switch to hydration fluid to keep vein open, and monitor—most reactions are self-limiting and resolve spontaneously. 2

• After 15 minutes of symptom resolution, rechallenge may be considered with careful monitoring 2
• If symptoms persist or worsen after 15 minutes, administer IV corticosteroid (hydrocortisone) 2
• Critical error to avoid: Do NOT use vasopressors or H1 blockers for complement activation-related pseudo-allergy, as this converts minor reactions into hemodynamically significant adverse events 5

Contraindications and Precautions

Absolute Contraindications

• Hypersensitivity to the active substance or excipients 1
• Known serious hypersensitivity to other parenteral iron products 1
• Active infection or ongoing bacteremia 1
• Anemia not attributed to iron deficiency 1
• Evidence of iron overload 1

Use with Caution

• Patients with drug allergies, severe asthma, eczema, or atopic allergies (increased hypersensitivity risk) 1
• Immune/inflammatory conditions (SLE, rheumatoid arthritis) 1
• Avoid concomitant administration with cardiotoxic chemotherapy; give before, after, or at end of treatment cycle 1

Post-Administration Monitoring

• Re-evaluate iron status at 3 months after correction dose 1
• Avoid early re-evaluation (within 4 weeks) as ferritin levels increase markedly post-IV iron and cannot accurately indicate iron status during this period 1
• Spuriously high transferrin saturation may occur shortly after IV iron administration due to circulating drug iron 1

Setting Requirements

IV iron can be administered in hospital or community settings where staff are trained and equipped to monitor for and manage hypersensitivity reactions. 1