IV Iron for Treatment of Iron Deficiency Anemia

If you have been diagnosed with iron deficiency with or without anemia, it may seem like an easy fix. "I'll just take some iron tabs, then everything will be fine." Although this is true for many people with iron deficiency, it can be much more complicated.

When determining which iron therapy is right for you, oral versus intravenous (IV), it is important to consider several factors. Those factors include:

• Age: Historically, infants and children have been treated with oral iron except in rare circumstances, like children who are unable to absorb oral iron due to gastrointestinal issues. In the adults, IV iron is used more commonly, particularly in people with ongoing bleeding or after gastric bypass surgery, which makes it difficult to absorb iron.
• Cost: Without question, oral iron is less expensive. It is readily available over the counter and may be the only choice in resource-poor settings. It can be given at home with little monitoring. IV iron must be administered in a clinic or hospital for monitored infusion which makes it more costly.
• Absorption: Some people are unable to absorb oral iron. Causes may include gastric bypass surgery (iron is absorbed in the stomach and requires gastric acid for absorption), celiac disease, inflammatory bowel disease, or after the Whipple procedure.
• Tolerance: Although oral iron is inexpensive, almost 70 percent of people taking oral iron complain of gastrointestinal side effects including nausea, constipation, stomach pain and/or vomiting. The liquid forms of oral iron, in particular, have a metallic taste and can cause staining of the teeth. Fortunately, the staining is temporary and can be minimized by brushing the teeth afterward. These side effects are common reasons why people do not take iron as recommended by their physician.

For many years IV iron was reserved for severe cases of iron deficiency anemia because the IV iron products available could cause allergic/anaphylactic reactions. However, newer formulations are safer and far less likely to have these reactions. Some but not all forms of IV iron will be reviewed below.

• Iron dextran: It is the least expensive version of IV iron. Iron deficiency can usually be corrected with only one infusion. Newer versions of iron dextran are less likely to cause allergic reactions than older formulations. Usually, a small test dose is given first and if well tolerated, the remainder of the dose is given. Sometimes medications are given prior to the IV iron in an attempt to prevent a reaction. This is the most common form used in children, although any of them can be used.
• Ferric gluconate: This form of IV iron can be given over multiple smaller doses. This formulation is commonly used in people receiving hemodialysis for severe kidney disease.
• Iron sucrose: Iron sucrose is also given over multiple smaller doses. If you are allergic to other medications, you may receive a small test dose first to ensure no reaction prior to receiving the remainder of the medication. This form of IV iron can be used in multiple settings including dialysis or in pregnant women.
• Ferric carboxymaltose: This medication is given in 1 or 2 infusions depending on the severity of your iron deficiency. It has been used safely in multiple settings including children with iron deficiency.

Iron deficiency is a common cause of anemia in the United States and worldwide. Although oral iron can be an easy, inexpensive treatment for many people, it may not be the best option for everyone. Discuss with your physician all your treatment options, including risks and benefits, prior to starting new medications.