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9.1.1 Iron deficiency anaemias, parenteral iron

9.1.1 Iron-deficiency anaemias

9.1.1.1 Oral iron

Ferrous fumarate tablets, syrup
Ferrous gluconate tablets
Ferrous sulphate tablets, MR (Ferrograd) tablets
Sodium feredetate elixir (Sytron)
Iron and Folic Acid
Ferrous fumarate + folic acid (Pregaday) tablets

Notes:

 1. A daily dosage of 100-200mg/day of elemental iron is usually satisfactory in uncomplicated cases.

3. Treatment should be continued for 3 months after a normal haemoglobin concentration is restored, in order to replace iron stores.

3. At equivalent dosage there is little to choose between iron preparations (Note that ferrous gluconate tablets contain less elemental iron than ferrous sulphate). See BNF for iron content of each salt.

4. Ferrous sulphate tablets are the least expensive.

5. All iron preparations may cause nausea and epigastric pain, which may subside if the dose is reduced.

6. Ferrograd may be helpful if ferrous sulphate is poorly tolerated. However, modified-release preparations of iron are likely to carry the iron into an area of the gut where iron absoprtion maybe poor, so a reduced amount of iron isabosebed overall.

 

9.1.1.2 Parenteral iron

Iron III hydroxide sucrose complex injection (Venofer®) IV use only - see note.
Iron dextran (Cosmofer) IV or IM Injection - see note. Go to SPC or Q&A on how to give
Ferric carboxymaltose (Ferinject) injection. Restricted use - see note. Go to SPC.

 

Notes:

1. Parenteral iron should only be undertaken in cases of proven iron deficiency where oral iron is ineffective or cannot be given e.g. due to malabsorption or serious non-compliance.

2. Parenteral iron does not produce a significantly faster haematological response than oral iron.

3. Life-threatening/serious allergic reactions (e.g. anaphylactoid reactions) may occur rarely with any parenteral iron form. These reactions can occur even when a previous administration has been tolerated, even a negative test dose. Caution is therefore required with every dose of IV iron, even if previous doses have been well tolerated. There is no evidence that an initial test dose minimises risk, and indeed it may give false reassurance. A test dose of iv iron is therefore no longer recommended.

4. The risk of hypersensitivity is increased in patients with: known allergies (including drug allergies); immune or inflammatory conditions (eg, systemic lupus erythematosus, rheumatoid arthritis); or those with a history of severe asthma, eczema, or other atopic allergy. In these patients, IV iron products should only be used if the benefits are clearly judged to outweigh the potential risks.  

5. IV iron should be given in an environment where the patient can be adequately monitored, and where resuscitation facilities are available. In case of a hypersensitivity reaction, treatment should be stopped immediately and appropriate management initiated. Patients should be monitored for at least 30 minutes post iv administration. See MHRA advice below.

6. Patients should be closely monitored for signs of hypersensitivity during and for at least 30 minutes after every administration of an IV iron product.

7. Iron sucrose injection administration table: this is available from the SPC .

8. Ferinject is restricted to use in chronic kidney disease, and other day-case patients, including Gastroenterology and Pregnancy Day Cases. It can be given as a single 15 minute infusion in a dose of up to 15mg/kg (maximum 1g).

9. Iron dextran (Cosmofer) total dose infusion is given over 4-6 hours. However, a slower rate of administration is recommended for the first 25 mg of iron given.

Link to MHRA Advice for IV iron and serious hypersensitivity reactions:

 

Links to BNF sections:

9.1.1 Iron-deficiency anaemias

9.1.1.1 Oral iron

9.1.1.2 Parenteral iron