General

Pronunciation:
fer-ik car-box-ee-mal-tose

Trade Name(s)

• Injectafer

Ther. Class.
antianemics

Pharm. Class.
iron supplements

Indications

Treatment of iron deficiency anemia in adults who cannot tolerate/have an unsatisfactory response to oral iron or who have chronic kidney disease (non-dialysis dependent)

Action

A colloidal iron complex that releases iron into circulation.

Therapeutic Effect(s):

Iron replacement with improvement in indeces and symptoms of iron deficiency.

Pharmacokinetics

Absorption: Iron released from colloid is rapidly bioavailable.

Distribution: Unk

Metabolism and Excretion: Iron is rapidly cleared from plasma and used in hemoglobin formation. Negligible renal elimination

Half-life: 7–12 hr

TIME/ACTION PROFILE (improved indeces)

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity.

Use Cautiously in:

• Geri:  Elderly may be more sensitive to effects;
• OB:   Use during pregnancy only if potential benefit justifies risk to fetus;
• Lactation: Use cautiously;
• Pedi:  Safe and effective use in children has not been established.

Adverse Reactions/Side Effects

CNS: dizziness, headache

CV: hypertension, hypotension

GI: constipation, dysgeusia, ↑ liver enzymes, nausea, vomiting

Derm: flushing

F and E: hypophosphatemia

Local: extravasation with skin discoloration

Misc: hypersensitivity reactions including anaphylaxis

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

None noted.

Route/Dosage

IV (Adults ≥50 kg): 750 mg, followed at least 7 days later by a second dose of 750 mg (total cumulative dose 1500 mg/course).

IV (Adults <50 kg): 15 mg/kg, followed at least 7 days later by a second dose of 15 mg/kg.

Availability

Iron complex for intravenous injection: 750 mg/15 mL single-use vial

Assessment

• Monitor for signs and symptoms of hypersensitivity reactions (hypotension, loss of consciousness, pruritus, rash, urticaria, wheezing) for at least 30 min and stable following completion of injection.
• Monitor for injection site for extravasation. May cause long lasting brown discoloration at site. If extravasation occurs, discontinue and administer at another site.
• Monitor BP during infusion. May cause transient hypertension. May cause facial flushing, dizziness and nausea. Usually resolved within 30 min following injection.

Lab Test Considerations: Monitor hemoglobin, serum ferritin, and transferrin saturation prior to and at completion of course of therapy.

• May cause ↑ ALT.

Potential Diagnoses

• Deficient knowledge, related to medication regimen (Patient/Family/Teaching) 

Implementation

• Dose is expressed in elemental iron. Each mL of ferric carboxymaltose contain 50 mg of elemental iron.

Patient/Family Teaching

• Explain purpose of ferric carboxymaltose to patient. Ask patient if they have a history of reactions to parenteral iron products.
• Advise patient to notify health care professional if signs and symptoms of hypersensitivity reaction occurs.
• Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications. Instruct patient to avoid taking iron supplements during therapy.
• Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

Treatment of iron deficiency anemia with improvements in hemoglobin, serum ferritin, and transferrin saturation.