IV Iron Does Not Directly Cause Photosensitivity
Intravenous iron itself is not a photosensitizing agent and does not cause photosensitivity reactions in patients. However, IV iron administration requires careful consideration in patients with specific porphyrias where iron metabolism plays a critical pathogenic role.
Key Distinction: Iron's Role in Porphyria vs. Direct Photosensitivity
IV iron is not listed among photosensitizing medications in comprehensive guideline reviews of drug-induced photosensitivity, which consistently identify tetracyclines, fluoroquinolones, NSAIDs, thiazide diuretics, and certain cardiovascular medications as the primary culprits 1
The documented risks of IV iron include acute infusion reactions, infection risk, and hypophosphatemia—not photosensitivity 2
Critical Caveat: Porphyria Cutanea Tarda (PCT)
In patients with PCT specifically, IV iron administration could theoretically worsen disease activity because iron overload is a central pathogenic mechanism in this condition 3, 4:
- PCT arises from inhibition of uroporphyrinogen decarboxylase (UROD) in the presence of hepatic iron and oxidative stress 4
- Most PCT patients have hepatic siderosis on liver biopsy, and the disease resolves with iron depletion through therapeutic phlebotomy 4
- Iron overload disrupts UROD enzymatic activity by inducing formation of an intracellular inhibitor 3
- Treatment of PCT requires iron reduction, not iron supplementation 3, 4
Clinical Approach for Patients with Porphyria
For patients with PCT:
- Avoid IV iron entirely—therapeutic phlebotomy to reduce total body iron is the standard treatment 4
- Alternative treatments include low-dose hydroxychloroquine to reduce hepatic porphyrin content 4
For patients with erythropoietic porphyrias (EPP, CEP, XLEPP):
- The relationship between iron and photosensitivity is complex and paradoxical 5, 6
- Iron restriction (through chelation) has actually been shown to reduce porphyrin accumulation and improve photosensitivity in congenital erythropoietic porphyria (CEP) 6
- IV iron is not contraindicated in erythropoietic porphyrias based on available evidence, though careful monitoring is warranted 5
Standard IV Iron Safety Monitoring
When administering IV iron to any patient, standard precautions apply 3, 2:
- Administer only where staff are trained to manage anaphylactic reactions with resuscitation facilities immediately available 3, 2
- Observe patients for at least 30 minutes following each administration 3, 2
- Withhold in patients with active bacteremia 3
- Monitor serum phosphate in patients receiving ferric carboxymaltose due to hypophosphatemia risk (58% incidence) 3
Bottom Line for Clinical Practice
- IV iron does not cause photosensitivity in the general population 2, 1
- Absolute contraindication: PCT patients should never receive IV iron as iron overload drives disease pathogenesis 3, 4
- Relative caution: Other porphyrias warrant individualized assessment, but IV iron is not inherently contraindicated 5, 6
- Screen patients with unexplained iron overload (ferritin >500 μg/L) for both hemochromatosis and PCT before administering IV iron 7