Anemia - Iron-Deficiency Drug Summary

Drug	Dosage	Remarks
Carbonyl iron1	50-90 mg PO 24 hourly	Adverse Reactions GI effects (GI irritation, abdominal pain, nausea/vomiting)  Special Instructions Should be taken with food and should not be used with antacids Contraindicated in patients with hemochromatosis and hemosiderosis Use with caution in patients with chronic liver failure, alcoholic cirrhosis, chronic alcoholism and pancreatic insufficiency
Fe (III) hydroxide polymaltose complex	100 mg PO 8-24 hourly	Adverse Reactions GI effects (constipation, diarrhea, dark stools, nausea/vomiting, epigastric pain, metallic taste) Special Instructions May be taken with meals to reduce GI discomfort May decrease absorption of iron if taken with antacids Contraindicated in patients with non-iron-deficiency anemia (eg hemolytic anemia), iron overload (eg hemochromatosis, hemosiderosis) or disturbances in iron utilization (eg thalassemia) Administer with caution in patients with GI disease (eg peptic ulcer disease, chronic ulcerative colitis, diverticular disease)
Ferric pyrophosphate	325 mg PO 24 hourly
Ferrous fumarate	200 mg PO 8-24 hourly
Ferrous gluconate	50 mg PO 24 hourly
Ferrous sulfate	As elemental iron: 65-200 mg PO 24 hourly in 2-3 divided doses
Iron protein succinylate (Iron proteinsuccinylate)	800 mg PO 12-24 hourly (equivalent to 40-80 mg of iron/day)
Sodium ferrous citrate	100-200 mg PO 24 hourly in 1-2 divided doses

*Various combination products are available. Please see the latest MIMS for specific formulations and prescribing information.
¹Iron dosages are in combination with folic acid, vitamins and minerals.

Drug	Dosage	Remarks
Ferric carboxymaltose	Adult and children >14 years old: Up to 1,000 mg IV injection/infusion 24 hourly but not more than once a week  May be given undiluted by IV injection up to a max of 15 mg/kg body wt: Doses between 200 and 500 mg of iron should be injected at a rate of 100 mg/min while those above 500 mg should be given over 15 minutes or May be given diluted in 0.9% NaCl by IV infusion up to a max of 20 mg/kg body wt Hemodialysis-dependent CKD: Single max daily injection of 200 mg iron may be given undiluted directly into the venous limb of the dialyser	Adverse Reactions CNS effects (headache, dizziness); Metabolic effects (increased alanine aminotransferase, hypophosphatemia); Other effects (high BP, nausea, injection site reactions)  Special Instructions Avoid paravenous leakage during administration Do not administer 20 mL as an injection or infusion more than once a week Monitor carefully during and following each administration for hypersensitivity reactions Contraindicated in patients with non-iron-deficiency anemia, iron overload or disturbance in utilization of iron Use with caution in patients with history of severe asthma, eczema or other allergies, immune or inflammatory conditions (eg SLE, rheumatoid arthritis), acute or chronic infection, liver disorders, patients on a Na-controlled diet, hemodialysis-dependent CKD patients receiving single doses of >200 mg iron Absorption of oral iron is reduced when administered concomitantly with parenteral iron preparations. Therefore, if required, oral iron therapy should not be started for at least 5 days after the last administration of Ferric carboxymaltose
Ferric derisomaltose  (Fe [III] isomaltoside 1,000)	Adult and elderly: Up to 500 mg IV bolus injection up to 3x/week at a rate of up to 250 mg iron/min May be administered undiluted or diluted in max 20 mL sterile 0.9% NaCl or Cumulative iron dose required may be administered in a single IV drip infusion of up to 20 mg iron/kg body wt or as weekly infusions until the cumulative iron dose has been administered  Doses up to 1,000 mg must be administered over >15 minutes; doses >1,000 mg must be administered over ≥30 minutes	Adverse Reactions GI effects (nausea/vomiting, abdominal pain, constipation); Other effects (blurred vision, numbness, dysphonia, dyspnea, flushing, pruritus, rash, cramps, anaphylactoid reactions, fever, inflammation near the injection site, local phlebitic reaction, soreness)  Special Instructions Monitor carefully during and following each administration for hypersensitivity reactions Avoid in patients with non-iron-deficiency anemia (eg hemolytic anemia), iron overload or disturbances in iron utilization (eg hemochromatosis, hemosiderosis), decompensated liver cirrhosis, active hepatitis, ongoing bacteremia Use with caution in patients with history of severe asthma, eczema or other atopic allergy, immune or inflammatory conditions, acute or chronic infection, compensated liver disease, porphyria cutanea tarda Should not be given concomitantly with oral iron preparations
Iron dextran	Individualized dosage according to the total iron deficit Adult and children >14 years old: 100-200 mg (2-4 mL) slow IM/IV injection 2-3 times weekly  If rapid iron delivery is required, administer as a total dose IV infusion up to a total replacement dose equal to 20 mg iron/kg body wt over 4-6 hours Can be administered diluted in 0.9% NaCl or 5% glucose solution by IV drip infusion or slow IV injection or as undiluted solution IM  Max dose: 100 mg (2 mL)/day IV/IM	Adverse Reactions CV effects (chest pain/tightness, shock, myocardial infarction, hypertension, hypotension, tachycardia, bradycardia, arrhythmias); Respiratory effects (breathing difficulty, dyspnea, bronchospasm, wheezing); CNS effects (headache, weakness, paresthesia, dizziness, disorientation, numbness, unconsciousness, vertigo); Musculoskeletal effects (joint pain, cramps, myalgia, arthritis); Dermatologic effects (urticaria, pruritus, purpura, rash); GI effects (nausea, emesis, abdominal pain, diarrhea); Other effects (lymphadenopathy, flushing, blurred vision, febrile episodes, chills, local reactions in the injection site, cyanosis) Special Instructions In inactive or bedridden patients, IM injection should be reduced to once or twice weekly Monitor carefully during and following each administration for hypersensitivity reactions Contraindicated in patients with non-iron-deficiency anemia (eg hemolytic anemia), iron overload or disturbances in iron utilization (eg hemochromatosis, hemosiderosis), decompensated liver cirrhosis and hepatitis, acute or chronic infection, acute renal failure Use with caution in patients with history of severe asthma, eczema or other atopic allergy, immune or inflammatory conditions (eg SLE, rheumatoid arthritis) Should not be administered concomitantly with oral iron preparations as the absorption of oral iron will be reduced. Oral iron therapy should not be started earlier than 5 days after the last administration of Iron dextran
Iron sucrose	Individualized dosage according to the total iron deficit Adult and elderly: 100-200 mg (5-10 mL) diluted IV drip infusion or undiluted slow IV injection 1-3 times weekly  Max dose:  As injection given not >3x/week: 100-200 mg (5-10 mL) injected for at least 5-10 minutes As infusion given not >1x/week: ≤70 kg: 7 mg/kg body wt infused over 3.5 hours >70 kg: 500 mg (25 mL) infused over 3.5 hours Dilution is 100 mg iron in max 100 mL 0.9% NaCl solution	Adverse Reactions GI effects (abdominal pain, diarrhea, nausea/vomiting, dysgeusia); Respiratory effects (pneumonia, cough, dyspnea); CV effects (chest pain, hypotension, hypertension, hypervolemia); Other effects (headache, fever, elevated liver enzymes, cramps, malaise, dizziness, pruritus, injection site reaction)  Special Instructions It is strongly alkaline and must not be given subcutaneously or intramuscularly Monitor carefully during and following each administration for hypersensitivity reactions Should not be given in patients with anemia not caused by iron deficiency, iron overload or disturbances in utilization of iron Use with caution in patients with history of asthma, eczema or other atopic allergies, immune or inflammatory conditions (eg SLE, rheumatoid arthritis), acute or chronic infection, liver dysfunction Should not be administered concomitantly with oral iron preparations since the absorption of oral iron is reduced. Oral iron therapy should at least be started 5 days after the last administration of Iron sucrose

All dosage recommendations are for non-elderly adults with normal renal and hepatic function unless otherwise stated.   
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.