indication

For treatment of patients with documented iron deficiency in whom oral administration is unsatisfactory or impossible. Also used to replenish body iron stores in Non-Dialysis Dependent-Chronic Kidney Disease (NDD-CKD) patients receiving or not receiving erythropoietin and in Hemodialysis Dependent (HDD-CKD) and Peritoneal Dialysis Dependent (PDD-CKD) - Chronic Kidney Disease patients receiving an erythropoietin.

pharmacology

Iron dextran is a dark brown, slightly viscous sterile liquid complex of ferric hydroxide and dextran for intravenous or intramuscular use. It is for treatment of patients with documented iron deficiency in whom oral administration is unsatisfactory or impossible. Iron is essential to the formation of hemoglobin and to the function and formation of other heme and nonheme compounds. Untreated depletion of iron stores leads to iron-deficient erythropoiesis and, in turn, to iron deficiency anemia.

mechanism of action

After iron dextran is injected, the circulating iron dextran is removed from the plasma by cells of the reticuloendothelial system, which split the complex into its components of iron and dextran. The iron is immediately bound to the available protein moieties to form hemosiderin or ferritin, the physiological forms of iron, or to a lesser extent to transferrin. This iron which is subject to physiological control replenishes hemoglobin and depleted iron stores.

toxicity

LD₅₀ = 500 mg/kg (mouse, IV). Dosages of iron dextran in excess of the requirements for restoration of hemoglobin and replenishment of iron stores may lead to hemosiderosis. Cases of severe, sometimes fatal, allergic reactions (loss of consciousness, collapse, difficulty breathing, hives, swelling, or convulsions) and severe low blood pressure (hypotension) have been reported with the use of iron dextran.

biotransformation

Dextran, a polyglucose, is either metabolized or excreted.

absorption

The major portion of intramuscular injections of iron dextran is absorbed within 72 hours; most of the remaining iron is absorbed over the ensuing 3 to 4 weeks.

half life

5 hours (some indications that it can be as long as 10 hours)

route of elimination

Dextran, a polyglucose, is either metabolized or excreted.

drug interactions

Alendronate: Formation of non-absorbable complexes

Ciprofloxacin: Formation of non-absorbable complexes

Clodronate: Formation of non-absorbable complexes

Demeclocycline: Formation of non-absorbable complexes

Doxycycline: Formation of non-absorbable complexes

Enoxacin: Formation of non-absorbable complexes

Etidronic acid: Formation of non-absorbable complexes

Gatifloxacin: Formation of non-absorbable complexes

Gemifloxacin: Formation of non-absorbable complexes

Grepafloxacin: Formation of non-absorbable complexes

Ibandronate: Formation of non-absorbable complexes

Levodopa: Iron decreases the absorption of dopa derivatives

Levofloxacin: Formation of non-absorbable complexes

Levothyroxine: Iron decreases the absorption of levothyroxine

Lomefloxacin: Formation of non-absorbable complexes

Methacycline: Formation of non-absorbable complexes

Methyldopa: Iron decreases the absorption of dopa derivatives

Minocycline: Formation of non-absorbable complexes

Moxifloxacin: Formation of non-absorbable complexes

Mycophenolate mofetil: Oral iron decreases the absorption of mycophenolate-mofetil

Norfloxacin: Formation of non-absorbable complexes

Ofloxacin: Formation of non-absorbable complexes

Oxytetracycline: Formation of non-absorbable complexes

Pefloxacin: Formation of non-absorbable complexes

Penicillamine: The multivalent agent decreases the effect of penicillamine

Risedronate: Formation of non-absorbable complexes

Temafloxacin: Formation of non-absorbable complexes

Tetracycline: Formation of non-absorbable complexes

Trovafloxacin: Formation of non-absorbable complexes