Ferric Carboxymaltose Infusion Rate for Severe Anemia
For a 60-year-old patient with hemoglobin of 6.6 g/dL, administer ferric carboxymaltose (FCM) 1000 mg intravenously over a minimum of 15 minutes. 1, 2
Dosing Protocol
The FDA-approved dosing for severe anemia (Hb <10 g/dL) in patients weighing ≥50 kg is 15 mg/kg body weight up to a maximum single dose of 750 mg, repeated after at least 7 days for a cumulative dose of 1,500 mg. 1 However, clinical practice and European guidelines support single doses up to 1000 mg. 3, 2
Infusion Rate Specifications
- Administer doses up to 1000 mg over a minimum of 15 minutes 1, 2, 4
- For doses exceeding 1000 mg, extend infusion time to at least 30 minutes 5
- No test dose is required before FCM administration 6
Clinical Context for This Patient
This patient's hemoglobin of 6.6 g/dL represents severe anemia requiring urgent correction. The FDA label specifically studied patients with hemoglobin levels in this range (as low as 6.7 g/dL in clinical trials). 1, 7
Dosing Strategy
For patients with hemoglobin ≤10 g/dL and body weight ≥50 kg, the recommended approach is:
- First dose: 750-1000 mg FCM over 15 minutes 1, 2
- Second dose: 750-1000 mg FCM administered at least 7 days after the first dose 1
- Total cumulative dose: 1,500-2,000 mg to achieve full iron repletion 1, 7
The European Society of Cardiology recommends 1500 mg as a single dose for patients ≥50 kg with hemoglobin ≤10 g/dL, though this may require extended infusion time. 5
Expected Outcomes
Hemoglobin should increase by 1-2 g/dL within 4-8 weeks of therapy. 5 In clinical trials of patients with severe anemia (mean baseline Hb 9.0-9.1 g/dL), FCM produced mean hemoglobin increases of 2.2-2.9 g/dL by day 35. 1
Rapid improvements occur within the first 1-2 weeks, with peak hemoglobin typically reached between days 35-56. 1, 4
Monitoring Parameters
Do not check iron parameters (ferritin, transferrin saturation) within the first 4 weeks after administration, as circulating iron interferes with assay results. 5
Reassess hemoglobin and iron parameters at 4-8 weeks post-infusion to determine if additional dosing is needed. 5, 1
Safety Considerations
FCM is well-tolerated with most adverse events being mild to moderate. 2, 4 Common side effects include headache, dizziness, nausea, and injection-site reactions. 2
The most important safety consideration is transient hypertensive episodes, which occur more frequently than with iron sucrose but are predominantly transient. 8
Contraindications include hemoglobin >15 g/dL, though this is not relevant for this patient. 5
Practical Administration
The 15-minute infusion time represents a significant advantage over older iron formulations like iron sucrose, which require multiple 200 mg doses administered 2-3 times weekly. 1, 2 This allows for complete iron repletion in just 1-2 visits rather than 5-10 visits. 6, 4