How to order slow-release iron for a patient with iron-deficiency anemia?

From the Guidelines

To order slow-release iron for an anemic patient, prescribe ferrous sulfate modified-release 325 mg (containing 105 mg elemental iron) once daily with food, as it is a cost-effective option with a relatively low incidence of gastrointestinal side effects 1. When selecting an oral iron preparation, consider the patient's tolerance and potential interactions with other medications. The British Society of Gastroenterology guidelines suggest that ferric maltol may be an alternative for patients with significant intolerance to traditional iron salts, as it has been shown to normalize hemoglobin levels in 63%–66% of cases with moderate iron deficiency anemia (IDA) and has a lower incidence of gastrointestinal side effects compared to traditional iron salts 1. Key considerations when ordering slow-release iron include:

• Starting with a once-daily dose of 50–100 mg of elemental iron, which may be the best compromise option for initial treatment 1
• Monitoring the initial hematological response and modifying the treatment regimen as needed 1
• Continuing oral iron for 2–3 months after hemoglobin normalization to replenish iron stores, although the optimal duration is unclear 1
• Instructing patients to take iron supplements with vitamin C-containing foods or orange juice to enhance absorption, but avoiding calcium-containing foods, coffee, tea, or antacids which decrease absorption
• Considering intravenous iron formulations for patients with severe intolerance to oral preparations or those who require rapid iron replacement 1 Regular monitoring of hemoglobin levels and ferritin levels is essential to assess the response to treatment and evaluate iron store repletion. The optimal interval for monitoring is not clear, but every 4 weeks until the hemoglobin is in the normal range seems reasonable 1.

From the FDA Drug Label

2 DOSAGE & ADMINISTRATION Venofer must only be administered intravenously either by slow injection or by infusion.

2.1 Mode of Administration Administer Venofer only intravenously by slow injection or by infusion. 2.2 Adult Patients with Hemodialysis Dependent-Chronic Kidney Disease (HDD-CKD) Administer Venofer 100 mg undiluted as a slow intravenous injection over 2 to 5 minutes, or as an infusion of 100 mg diluted in a maximum of 100 mL of 0.9% NaCl over a period of at least 15 minutes, per consecutive hemodialysis session 2.3 Adult Patients with Non-Dialysis Dependent-Chronic Kidney Disease (NDD-CKD) Administer Venofer 200 mg undiluted as a slow intravenous injection over 2 to 5 minutes or as an infusion of 200 mg in a maximum of 100 mL of 0. 9% NaCl over a period of 15 minutes.

To order slow release iron for an anemic patient, Venofer can be administered intravenously either by slow injection or by infusion. The dosage of Venofer is expressed in mg of elemental iron.

• For Adult Patients with Hemodialysis Dependent-Chronic Kidney Disease (HDD-CKD): Administer Venofer 100 mg undiluted as a slow intravenous injection over 2 to 5 minutes, or as an infusion of 100 mg diluted in a maximum of 100 mL of 0.9% NaCl over a period of at least 15 minutes, per consecutive hemodialysis session.
• For Adult Patients with Non-Dialysis Dependent-Chronic Kidney Disease (NDD-CKD): Administer Venofer 200 mg undiluted as a slow intravenous injection over 2 to 5 minutes or as an infusion of 200 mg in a maximum of 100 mL of 0.9% NaCl over a period of 15 minutes 2.

From the Research

Ordering Slow Release Iron for Anemic Patients

To order slow release iron for anemic patients, consider the following options:

• Oral iron supplementation is the first line of treatment for iron-deficiency anemia, with ferrous sulfate being the simplest and most commonly prescribed drug 3.
• Novel iron formulations, such as ferric maltol or nanoparticle encapsulated sucrosomial iron, have been developed for oral iron supplementation 3.
• Intravenous iron therapy can be used for patients who are intolerant to oral iron or have impaired absorption, and can rapidly achieve therapeutic targets without gastrointestinal complications 3, 4, 5.
• The choice of iron therapy depends on the individual patient's needs and circumstances, such as the presence of chronic inflammatory conditions or ongoing blood loss 4, 5.

Factors to Consider

When ordering slow release iron for anemic patients, consider the following factors:

• The patient's iron deficiency status, including serum ferritin and transferrin saturation levels 4.
• The presence of any underlying medical conditions, such as chronic kidney disease or heart failure, that may affect iron absorption or increase the risk of adverse effects 4, 5.
• The patient's ability to tolerate oral iron supplementation, including any history of gastrointestinal side effects or allergic reactions 3, 4, 6.
• The need for rapid correction of iron deficiency, which may require intravenous iron therapy 5.

Available Formulations

The following slow release iron formulations are available:

• Ferrous sulfate, which is the most commonly prescribed oral iron supplement 3, 7.
• Ferric maltol, a novel oral iron formulation that has been shown to be effective in correcting iron-deficiency anemia 3.
• Nanoparticle encapsulated sucrosomial iron, another novel oral iron formulation that has been developed for the treatment of iron-deficiency anemia 3.
• Intravenous iron formulations, such as iron dextran, iron derisomaltose, ferric carboxymaltose, ferrumoxytol, iron sucrose, and sodium ferric gluconate, which can be used for patients who require rapid correction of iron deficiency or are intolerant to oral iron 5.