Ferric Derisomaltose Dosing for Iron Deficiency Anemia
For patients weighing ≥50 kg, administer 1000 mg of ferric derisomaltose as a single intravenous infusion over at least 20 minutes; for patients <50 kg, administer 20 mg/kg as a single dose. 1
Weight-Based Dosing Algorithm
Patients ≥50 kg:
- Standard dose: 1000 mg IV over at least 20 minutes 1
- For hemoglobin ≤10 g/dL: Consider 1500 mg as a single dose (European guidelines support higher dosing in this scenario) 2
- Repeat the dose if iron deficiency anemia recurs 1
Patients <50 kg:
- Dose: 20 mg/kg actual body weight IV over at least 20 minutes 1
- For hemoglobin >10 g/dL: 500 mg as a single dose 2
- For hemoglobin ≤10 g/dL: 1000 mg as a single dose 2
Preparation and Administration
- Dilute the appropriate volume in 100-500 mL of 0.9% sodium chloride 1
- Final concentration must be >1 mg iron/mL 1
- Infuse over at least 20 minutes for doses ≤1000 mg 1
- For doses >1000 mg, infuse over 30 minutes or more 2
- Each mL contains 100 mg of elemental iron 1
Critical Safety Requirements
Only administer when personnel and therapies for treating serious hypersensitivity reactions are immediately available. 1
- Monitor patients for at least 30 minutes after infusion completion and until clinically stable 1
- Resuscitation facilities must be available during administration 3
- Do not administer if hemoglobin >15 g/dL 2
Monitoring Timeline
- Do not check iron parameters within 4 weeks of administration - circulating iron interferes with assay results 2, 3
- Check CBC and iron parameters (ferritin, transferrin saturation) at 4-8 weeks after infusion 2, 3
- Hemoglobin should increase within 1-2 weeks and rise by 1-2 g/dL within 4-8 weeks 2, 3
- Re-evaluate iron status at 3 months, as ferritin is markedly elevated immediately post-infusion 2, 3
Key Advantages Over Other IV Iron Formulations
Ferric derisomaltose is the only FDA-approved IV iron for total dose infusion, allowing complete iron repletion in a single visit 2, 3
- Significantly lower hypophosphatemia risk (4%) compared to ferric carboxymaltose (58%) 4
- Demonstrates cardiovascular mortality benefit in heart failure patients 2, 3
- Faster hematological response compared to iron sucrose 5, 6
- Fewer clinic visits required (typically 1-2 versus 4-7 for iron sucrose) 4
Specific Clinical Indications
Ferric derisomaltose is indicated for: 3, 1
- Intolerance to oral iron therapy
- Inadequate response to oral iron therapy
- Need for rapid iron repletion
- Non-hemodialysis dependent chronic kidney disease
- Active inflammatory bowel disease with impaired absorption
- Post-bariatric surgery with disrupted duodenal absorption
Important Contraindications and Precautions
- Contraindicated in patients with prior serious hypersensitivity to ferric derisomaltose or any component 1
- Avoid same-day administration with anthracyclines in cancer patients due to theoretical cardiotoxicity risk 3
- Use caution in patients with acute/chronic infection; stop treatment if bacteremia develops 4
- Monitor for extravasation - can cause long-lasting brown discoloration 1