Acute hypersensitivity reaction to ferric gluconate in a premedicated patient.
OBJECTIVE
To report a case of an acute hypersensitivity reaction to ferric gluconate in a patient premedicated with dexamethasone, diphenhydramine, and prochlorperazine.


METHODS
A 38-year-old female with persistent iron deficiency anemia was initiated on parenteral iron therapy with ferric gluconate 125 mg intravenously over 10 minutes. The patient initially tolerated this first dose well; however, she later experienced nausea, dizziness, and minor tongue swelling. On her second course of therapy, the woman was premedicated with dexamethasone, diphenhydramine, and prochlorperazine prior to the same dose of ferric gluconate infused over 30 minutes. Subsequently, the patient developed epigastric pain, nausea, swelling of her lips and tongue, and hypotension. The symptoms abated after administration of diphenhydramine, dexamethasone, morphine, cimetidine, intravenous fluids, and oxygen. She was discharged after a short stay in the emergency department observation unit.


CONCLUSIONS
Data are limited on the relative safety of ferric gluconate compared with iron dextran. Ferric gluconate does not appear to be associated with severe life-threatening events; however, the possibility of an acute hypersensitivity reaction with this product does exist. In this case, use of the Naranjo probability scale indicated a probable relationship between the hypersensitivity reaction and ferric gluconate.


CONCLUSIONS
Healthcare professionals should be aware of this serious but rare event and encouraged to further document and report these events.
Saadeh
Claire E
CE
Pharmacy Practice, Ferris State University, Department of Pharmacy, Sparrow Health System, Lansing, MI 48912, USA. saadehc@ferris.edu
Srkalovic
Gordan
G
D000328:Adult; D000747:Anemia, Hypochromic / Q000150:complications / Q000188:drug therapy; D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000009:adverse effects; D003907:Dexamethasone / Q000009:adverse effects; D004155:Diphenhydramine / Q000009:adverse effects; D004342:Drug Hypersensitivity / Q000503:physiopathology*; D005260:Female; D005290:Ferric Compounds / Q000009:adverse effects*; D006634:Histamine H1 Antagonists / Q000009:adverse effects; D006801:Humans; D011346:Prochlorperazine / Q000009:adverse effects
D000893:Anti-Inflammatory Agents; D014150:Antipsychotic Agents; D005290:Ferric Compounds; D006634:Histamine H1 Antagonists; D003907:Dexamethasone; D004155:Diphenhydramine; C035552:ferric gluconate; D011346:Prochlorperazine