Use of iron in perinatal anaemia: Indications for women’s health care policies and procedure

Table 1 Intravenous iron preparations

Name	Components	Trade name	Maximum dose and metabolism	Administration	Side effects	Contraindications and precautions
Iron sucrose[30,51,76,77]	Polynuclear iron (III) hydroxide in sucrose. Dose of elemental iron = 20 mg/mL	Venofer®	Maximum dose for a single infusion is 300 mg. The infusion can be repeated up to 3 times per week. After administration, it reaches peak level at 10 min after infusion. Half-life is about 6-20 h	Test dose is required if drug allergies present, only for the first dose administration and only in new patients. Intravenous infusion should be given within at least 15 min	Anaphylaxis phlebitis; Pain and swelling in the infusion area; Constipation; Blurred vision; Headache; Pruritus and rash; Drowsiness; Metallic taste; Slow or fast heartbeat; Sweating; Tingling of the hands or feet; Unusual tiredness or weakness	First trimester of pregnancy; Hypersensitivity to iron sucrose; Anaemia not caused by iron deficiency; Iron overload; Known or genetic tendency to haemochromatosis; Lactation (insufficient data)
Iron dextran[30,78]	Ferric hydroxide or ferric oxyhydroxide combined with partially hydrolysed low molecular-weight dextran; Dose of elemental iron = 50 mg/mL	INFeD® (IV or IM use); Cosmofer® (low molecular weight – both IV and IM routes of administration)	The intravenous dose is 100-200 mg (or 20 mg/kg), administered ≤ 3 times per week. Reticulocytosis may begin by 4th day after the intravenous infusion of the total dose. Peak level Reaches a maximum by about 10th day. Half-life is about 5-30 h	Test dose is required before every intravenous administration. Intravenous infusion should be given within 4-6 h. Intramuscular injection of 100 Cosmofer can be injected into alternate buttocks ≤ 3 times per week	Anaphylaxis; Arthralgia; Chills; Dizziness; Fever; Headache; Malaise; Myalgia; Metallic taste; Pain and swelling in the infusion area; Low blood pressure	Heart disease; Liver disease; Kidney disease; Rheumatoid arthritis; Bleeding or blood clotting disorder; Stomach bleeding; Asthma or allergies; Allergy; Using a beta-blocker medicine; Pregnancy
Iron polymaltose[57,79]	Iron (III) –hydroxide (trivalent iron, Fe3+) with the carrier polymaltose	FerrumH®; Ferrosig®	Each 2 mL ampoule contains 318 mg iron polymaltose equivalent to 100 mg iron III (50 mg per mL). It is used for postnatal women when the required dose of iron is > 1000 mg. Average total dose of iron polymaltose infusion is usually between 1000-2500 mg for adults. Maximum dose for a single infusion is 2500 mg	Total dose is administered within 5 h; The first 50 mL should be administered slowly (5-10 drops/min); The intravenous preparation should not be mixed with any other medication	Anaphylaxis; Itching; Mild erythematous or urticarial rash; Lower quadrant abdominal pain; Dizziness; Chest and back pain; Occasional arrhythmias; Dyspnoea; Flushing; Sweating; Injection/infusion site pain	First trimester of pregnancy; Iron overload; Chronic polyarthritis; Acute renal infection; Uncontrolled hyperparathyroidism; Hepatic cirrhosis; Infectious hepatitis; Liver infection; Bronchial asthma; Anaemia not caused by iron deficiency (i.e. microcytic anaemia); Iron overload; Anaemia not caused by iron deficiency (i.e. microcytic anaemia); Iron overload; Lactation (no data available)
Iron carboxymaltose[30,51,80]	Ferric carboxymaltose. Dose of elemental iron = 50 mg/mL.	Ferinject®; Ferrosig®	Each vial contains 50 mg/mL Ferric carboxymaltose and they come as 2 mL (100 mg) or 10 mL (500 mg) vials. Maximum dose for a single infusion for patients ≥ 35 kg is 1000 mg/wk, or a maximum of 15 mg/kg/wk can be administered. Administered IV dose is 1000 mg or up to 15 mg/kg/wk. Half-life is about 7-12 h	Test dose is not required before intravenous administration. It is administered within 30-45 min	Anaphylaxis (rare); Headache; Gastrointestinal symptoms; Nausea; Rash; Injection/infusion site reactions; Hypophosphataemia; Flushing; Dizziness; Hypertension	Anaemia not caused by iron deficiency (i.e. microcytic anaemia); Iron overload; Acute or chronic infection; Asthma; Eczema; Atopic allergies; Liver dysfunction; Children under 14 yr
Iron isomaltoside[30]	Dose of elemental iron (ferric derisomaltose) = 100 mg/mL	Monofer®	Administered IV dose is 100-200 mg up to 3 times a week. Half-life is about 1-4 d	Test dose is not required before intravenous administration. Doses up to 10 mg/Kg should be administered within at least 30 min. Doses larger than 10 mg/kg should be administered within at least one hour	Anaphylaxis; Infusion site complications; Myalgia; Phlebitis; Headache; Tachycardia; Hypotension; Hypertension; Chest pain; Dyspnoea; Bronchospasm; Abdominal pain; Vomiting; Dyspepsia; Constipation; Diarrhoea; Hypophosphataemia	Hypersensitivity to ferric substances; Non-iron deficiency anaemia; Iron overload; Unavailability of resuscitation facility; Liver dysfunction; Chronic infection; Asthma; Eczema; Atopic allergies; Ongoing bacteraemia; First trimester of pregnancy; Lactation (no data available)
Ferumoxytol[81]	Superparamagnetic iron oxide comound linked to polyglucose sorbitol carboxymethylether; Dose of elemental iron = 30 mg/mL	Feraheme®	Maximum dose for a single infusion is 510 mg	510 mg Ferumoxytol is Administered over within 15-30 min. Second dose of 510 mg is administered approximately one week later	Anaphylaxis; Abdominal pain; Headache; Blurred vision; Confusion; Fever; Flush; Chest tightness; Back pain; Nausea; Nasal congestion; Itching; Scratchy throat and cough; Sweating; Hands or feet tingling	Hypersensitivity to ferric substances; Iron overload syndrome; Low blood pressure; Non-iron deficiency anaemia; Hypotension; MRI study; First trimester of pregnancy; Lactation (no data available)
Iron gluconate[48]	Dose of elemental iron = 12.5 mg/mL with Benxyl alcohol as preservative	Ferrlecit®	Maximum dose for a single infusion is 125 mg. Half-life is 1 h	Test dose is required if drug allergies present	Allergic reaction; Rash; Itching; Swelling; Severe dizziness; Difficulty breathing; Nausea; Vomiting; Diarrhoea; Loss of appetite; Stomach pain; Leg cramps; Swelling of extremities; Headache	Allery; Iron overload syndrome; Haemolytic anaemia; Ulcerative colitis; Stomach ulcers; Thalassemia; Receiving regular blood transfusions; First trimester of pregnancy; Lactation (no data available)