title: Comparative rates of adverse events with different formulations of intravenous iron.
abstract: Oral iron replacement is the standard therapy in iron-deficiency anemia (IDA). However, 59% of patients have gastrointestinal toxicity. With impaired iron uptake from the gastrointestinal tract (in anemia of chronic disease (ACD) or after bariatric surgery), suboptimal responsiveness to exogenous erythropoietin (in chronic renal failure), in patients with cancer receiving chemotherapy, or when oral iron is poorly tolerated, IV iron therapy is the preferred mode of repletion. Although effective in increasing hemoglobin, the relative safety of the available IV iron preparations is not well documented. We examined the comparative safety of IV iron formulations used at hospitals associated with our institution. Among 619 unique patients who received IV iron over a 2-year period, we found 32 adverse events (AEs), ranging from urticaria to chest pain. There were no serious AEs or anaphylactic-type reactions. In a multivariate model, there was no difference in AE rates between low-molecular-weight iron dextran (LMWD) and ferric gluconate; however, iron sucrose had significantly higher odds ratio of AEs (OR = 5.7; 95% CI = 1.6–21.3). Our data suggest that AE rates with IV iron are acceptable. More widespread use of LMWD, in particular, which can be given safely as a total dose infusion (TDI), should be considered.
authors.affiliation: Division of Hematology, Brigham and Women's Hospital, Boston, MA 02115, USA. mokam@partners.org
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Okam
authors.forename: Elyse
authors.initials: E
authors.lastname: Mandell
authors.forename: Nathanael
authors.initials: N
authors.lastname: Hevelone
authors.forename: Rachel
authors.initials: R
authors.lastname: Wentz
authors.forename: Ainsley
authors.initials: A
authors.lastname: Ross
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Abel
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000188:drug therapy*; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006397:Hematinics / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007275:Injections, Intravenous; D007505:Iron-Dextran Complex / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies
chemical_list: D005290:Ferric Compounds; D006397:Hematinics; D006454:Hemoglobins; D007505:Iron-Dextran Complex; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid; C035552:ferric gluconate