Intravenous low-molecular weight iron dextran is indicated for patients with iron deficiency who are unable to take oral iron or experience insufficient efficacy with oral replacement. Adverse effects have been reported, including anaphylaxis and death. The primary purpose of this study was to determine the proportion of patients experiencing adverse reactions in a wide range of patients and to categorize the types of reactions experienced. The second purpose was to provide insight into the potential factors that contribute to reactions to iron dextran.
Methods:
This is a retrospective study evaluating all patients receiving intravenous iron dextran hospitalized at a single academic medical center between July 1, 2014 and July 31, 2015. Baseline demographics, concurrent steroid use, premedications, date/time of test dose and infusion, dose of infusion, reactions to test dose and/or infusion, and allergies were collected. The primary outcome was the proportion of patients experiencing adverse reactions. Categories of adverse reactions assessed included anaphylaxis, cardiovascular, dermatologic, gastrointestinal, musculoskeletal, neurologic and respiratory. Patients were segregated based on presence of adverse reaction, and differences in baseline characteristics were assessed.
Results:
Final analysis included 406 patients with baseline characteristics shown in Table 1. Reactions to the test dose or infusion were reported in 11 (11/406=2.7%) and 21 patients (21/406=5.2%) respectively. Reported reactions were cardiovascular (13/406=3.2%), musculoskeletal/soft tissue (8/406=2.0%), gastrointestinal (6/406=1.5%), neurological (6/406=1.5%), dermatologic (2/406=0.5%), and respiratory (3/406=0.7%) in nature and treatable with diphenhydramine, acetaminophen, oxycodone, ondansetron, methylprednisolone, metoprolol, famotidine, and/or epinephrine. Premedications, including methylprednisolone (10/406=2.5%), diphenhydramine (7/406=1.7%), and acetaminophen (2/406=0.5%) were administered to a total of 17 patients (17/406=4.2%), and adverse reactions were reported in 3 of these patients (3/17=17.6%). Use of daily steroids, including prednisone (202/406=49.8%), dexamethasone (1/406=0.2%), methylprednisolone (1/406=0.2%), or hydrocortisone (1/406=0.2%), was reported in a total of 205 patients (205/406=50.5%) with 16 of these patients (16/205=7.8%) experiencing an adverse reaction. Overall, as shown in Table 2 below, the patients who experienced reactions to iron dextran were younger (49.8 years v. 55.8 years), and a greater proportion were male (59.4% v. 52.9%) and Caucasian (62.5% v. 58.3%). Patients experiencing reactions also reported fewer allergies with 71.9% reporting 0 or 1 allergy compared to 66.6% of those not experiencing any reaction.
Conclusions:
Although adverse reactions occurred, life-threatening reactions were rarely reported in this population. The low incidence of anaphylaxis supports that iron dextran is a safe option for treating iron deficiency in this population. Daily corticosteroid use did not appear to be associated with a decreased incidence of adverse reactions. Increased incidence of adverse reactions may be correlated with younger, male, and Caucasian patients. This study also indicates that an increased number of reported allergies does not appear to correlate with an increased risk of adverse reactions.