Friday, April 3, 2020

Comparing Iron Injections : Iron Sucrose VS Iron Dextran ( Venofer / Hemofer VS CosmoFer )


Iron Sucrose (Venofer)
Iron Dextran (Cosmofer)
Strength
100mg/5ml
[Elemental Iron = 20 MG/ML]
100 mg / 2 ml
 [Elemental Iron = 50 MG/ML]
Dose Recommended
Adult and the elderly:
100-200 mg iron, 1-3 times per week (depending on Hb level)

Maximum tolerated dose (MTD)
As injection : MTD per day (max. 200mg iron) given 3 times per week

As infusion : Maximum tolerated single dose per day (max. 500 mg) given once per week: (give each dose over at least 3.5 hours)
    Patient >70 kg : 500 mg iron sucrose
    Patient ≤70 kg : 7 mg iron/kg body weight

Adult:
100-200mg iron, 2-3x/week (depending on Hb level)

Maybe administered as a total dose infusion up to a total replacement dose corresponding to 20mg iron/kg bw
Calculation of Dose
Refer table 1

If the total necessary dose exceeds the maximum allowed single dose, then the administration has to be split (refer to “MTD” section in “DOSE” above).
Refer Table 2
Advantage
Test dose not required but recommended in patient  with history of drug allergy
Maybe administered as a total dose infusion up to a total replacement dose corresponding to 20mg iron/kg bw
Disadvantage
There’s  maximum tolerated dose
Requires test dose
Liver adjustment
No dose adjustment
No dose adjustment, use with extreme caution
Contraindication
·         Hypersensitivity to the active substance,
·         Known serious hypersensitivity to other parenteral iron products
·         Anaemia not caused by iron deficiency
·         Evidence of iron overload or hereditary disturbances in utilisation of iron.
·         Hypersensitivity to the active substance,
·         Known serious hypersensitivity to other parenteral iron products.
·         Non-iron deficiency anaemia (e.g. haemolytic anaemia).
·         Iron overload or disturbances in utilisation of iron (e.g. haemochromatosis, haemosiderosis).
·         Decompensated liver cirrhosis and hepatitis.
·         Acute or chronic infection, because parenteral iron administration may exacerbate bacterial or viral infections.
·         Acute renal failure.

 .
·         In practice, there is no evidence that total doses above 1000mg elemental iron are clinically useful.
·         Fixed dose of 1000mg, generally sufficient to treat anemia and provide additional storage of iron without causing iron overload.
·         Intravenous iron results in replenishment of iron stores with peak ferritin concentration at 7-9 days. In our experience, HB should rise within 2-3 weeks in majority patients.

Ganzoni formula (for iron deficiency anaemia):
Total iron deficit (mg) = Body Weight (kg) x (Target Hb - Actual Hb; both in g/dL) x 2.4 + Depot Iron (mg)*

*Depot
< 35 kg (Target Hb = 13 g/dL)
Depot = 15 mg/kg body weight
≥ 35 kg (Target Hb = 15 g/dL)
Depot = 500 mg

*For blood loss, can apply the same formula but NO need to add in the depot iron.


Table 1: Venofer Dosing Table
(value in the table denotes : number of ampoules to be administered)


Body Weight (kg)
40
45
50
55
60
65
70
75
80
85
90
95
100
Increase in Hb Required (g/dL) #
1
6
6
6
6
6
7
7
7
7
7
7
7
7
2
7
7
7
8
8
8
8
9
9
9
9
10
10
3
8
8
9
9
9
10
10
10
11
11
11
12
12
4
9
9
10
10
11
11
12
12
13
13
14
14
15
5
10
10
11
12
13
13
13
14
15
15
16
16
17
6
11
11
12
13
14
14
15
16
17
17
18
19
19
7
12
12
13
14
15
16
17
18
18
19
20
21
22

# Increase in Hb Required = Target Hb minus Actual Hb

If given as infusion, maximum tolerated single dose (given once per week) is to be given as follow:
Body weight
Maximum tolerated single dose of iron
70 kg
7 mg iron/kg body weight
>70 kg
500 mg iron sucrose
 
Please note that this table is NOT the SAME as the one available under section of Iron Sucrose Injection in: Injectable Drugs: Preparation & Administartion Guide for Hospital Keningau (2nd Edi. 2019).


Table 2: Cosmofer Dosing Table
Total number of ampoules of CosmoFer
to be administered in iron-deficiency  anaemia:


Body Weight (kg)
40
45
50
55
60
65
70
75
80
85
90
Actual Hb (g/dL)
6.0
14
15
16
17
18
19
20
21
22
23
24
7.5
12
13
14
15
16
17
18
19
19
20
21
9.0
11
12
12
13
14
14
15
16
17
17
18
10.5
9
10
10
11
12
12
13
13
14
14
15
12.0
8
8
9
9
9
10
10
10
11
11
12
13.5
6
7
7
7
7
7
8
8
8
8
8

P/S: If the total exceeds TDI or 20 mg/kg, it is recommended to split the dose.


Please note that this table is NOT the SAME as the one available under section of Iron Dextran Injection in: Injectable Drugs: Preparation & Administartion Guide for Hospital Keningau (2nd Edi. 2019).


References:
1.        Product Leaflet: Iron Dextran (CosmoFer)
2.        Product Leaflet: Iron Sucrose (Venofer)
3.        Product Leaflet: Iron Sucrose (Hemofer)
4.        Product Summary from Manufacturer: Iron Dextran (CosmoFer)
5.        Product Summary from Manufacturer: Iron Sucrose (Venofer)
6.        Uptodate
7.        Correcting Iron Deficiency  , retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5155066/


Prepared by Nur Nabiha R.
Edited by Mohd Zulhelmy & JCK Ho
[3 April 2020]

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