IDENTIFICATION AND USE: Iron dextran is a dark brown, slightly viscous solution. Intravenous or intramuscular injection of iron dextran is indicated for treatment of patients with documented iron deficiency in which oral administration is unsatisfactory or impossible. HUMAN EXPOSURE AND TOXICITY: Overdosage with iron dextran is unlikely to be associated with any acute manifestations. Dosages of iron dextran in excess of the requirements for restoration of hemoglobin and replenishment of iron stores may lead to hemosiderosis. Periodic monitoring of serum ferritin levels may be helpful in recognizing a deleterious progressive accumulation of iron resulting from impaired uptake of iron from the reticuloendothelial system in concurrent medical conditions such as chronic renal failure, Hodgkin's disease, and rheumatoid arthritis. Anaphylactic or anaphylactoid reactions to iron dextran, including fatal anaphylaxis, have been reported. These reactions occur most frequently within the first several minutes of administration and are generally characterized by sudden onset of respiratory difficulty (e.g., wheezing, bronchospasm, rigor, dyspnea, and cyanosis), tachycardia, hypotension, respiratory arrest, and/or cardiovascular collapse. The manufacturers state that concomitant use of angiotensin-converting enzyme (ACE) inhibitors may increase the risk for reactions to iron dextran. Acute hypersensitivity reactions to iron dextran have been estimated to occur in 0.2-3% of patients. These reactions have been reported after administration of uneventful test doses of iron dextran as well as after therapeutic doses of the drug. Although it has been suggested that severe systemic reactions, including anaphylactoid reactions, are more common following IV rather than IM administration of iron dextran, the risk of severe systemic reactions following IV or IM administration has not been directly compared and there appears to be no well-substantiated evidence of a difference in the frequency of anaphylactoid reactions following either route of administration. ANIMAL STUDIES: Rats treated with iron dextran by intramuscular injection at a total dose of 100 mg of iron/kg in divided doses over a 12-week period exhibited no drug-related abnormalities. At ten times this dose, 1000 mg of iron/kg, treated rats had enlarged livers and spleens compared to control rats. Iron dextran is reasonably anticipated to be a human carcinogen based on sufficient evidence of carcinogenicity from studies in experimental animals. Three male and three female rabbits were given 28 once-weekly im injections of 2 mL iron-dextran starting at 6 months of age and were observed for up to four years after the first injection. Two developed pleomorphic sarcoma at 39 and 48 months after the first injection, and 1 of the sarcomas metastasized to the lungs. No distant primary tumors were seen. Rats were given repeated im injections over 4 months (totaling 1250 mg iron in males and 800 mg iron in females). Local sarcomas, several of which were transplantable, developed in 13/18 rats between 8 and 10 months after the first injection of iron-dextran. In another study, researchers found 41 sarcomas, 6 histiocytomas and 1 epithelioma at the injection site in 70/95 mice that survived from 6 to 18 months after the start of a course of once-weekly sc doses of 0.2 or 0.3 mL of iron-dextran from 11 wk to 7.5 months. Mice injected with dextran only developed no tumors. When a single sc doses of iron dextran equivalent to 25-2500 mg/kg bw of trivalent iron were given to groups mice of different numbers (6 to 44 males and 8 to 60 females), altogether three local tumors (1 sarcoma, 2 unspecified) developed in 3 females (1/53 on 500 mg/kg, 1/10 on 1000 mg/kg and 1/8 on 2500 mg/kg). However, an increase in the incidence of distant tumors was noted only in females (61/137 test females versus 13/60 control females), and two-thirds of these tumors were of lymphoreticular origin. Intravenous injection of three doses of 50 mg iron/kg (total dose 150 mg Fe/kg) as iron dextran into rabbits late in pregnancy (days 26, 28 and 30 of gestation) reduced the weight gain of the dams and increased fetal mortality. Three doses of 20 mg Fe/kg also increased fetal mortality, while three doses of 5 mg Fe/kg were without effect. In the rat four i.v. doses of 200 mg Fe/kg as iron dextran on days 17, 18, 19, and 20 of gestation (total dose 800 mg Fe/kg) produced tremors, reduced body weight gain, and reduced food consumption in the dams. The growth and survival of the offspring were adversely influenced by these effects on the dam. No iron-induced pathology was evident in the offspring of either rabbits or rats after 14 and 18 weeks, respectively.
Classification of carcinogenicity: 1) evidence in humans: inadequate; 2) evidence in animals: sufficient. Overall summary evaluation of carcinogenic risk to humans is Group 2B: The agent is possibly carcinogenic to humans. /From table/
The major portion of intramuscular injections of iron dextran is absorbed within 72 hours; most of the remaining iron is absorbed over the ensuing 3 to 4 weeks.
Following intramuscular administration, iron dextran is absorbed from the site of injection primarily through the lymphatic system. Absorption takes place in two stages. Approximately 60% of the dose or iron dextran inected is absorbed within 72 hours of administration. Ninety percent of the dose is absorbed in the second, slower, phase lasting approximately 1 to 3 weeks in duration. The remaining 10% of the dose is gradually absorbed over a period of several months or longer.
Following IM or IV injection, iron dextran is gradually cleared from plasma by reticuloendothelial cells of liver, spleen, and bone marrow. Results of several studies indicate that /a/ variable portion of IV dose... may be stored in unusable form in bone marrow.