#venofer

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Common Brand Names: Infed (iron dextran), Venofer (iron sucrose)

Therapeutic Class: Essential mineral and blood modifier

Common Injectable Dosage Forms:

Iron Dextran, Solution for Injection: 50 mg/mL (2 mL)

Iron Sucrose, Solution for Injection: 20 mg/mL (5 mL)

Dosage Ranges:

Iron Dextran:

Children <15 kg: 0.0442 (desired hemoglobin – observed hemoglobin) x W ÷ (0.26 x W) Note: W=weight in kg, desired hemoglobin usually 12 g/dL.

Adults and children >15 kg: 0.0442 (desired hemoglobin - observed hemoglobin) x LBW ÷ (0.26 x LBW). Note: LBW=lean body weight in kg, desired hemoglobin usually 14.8 g/dL. A test dose of 0.5 mL should be given first day of therapy.

Iron Sucrose: 100-300 mg administered 1-3 times per week to a cumulative total maximum dose of 1000 mg; may administer lower doses to maintain target hemoglobin, hematocrit, and iron storage parameters.

Administration and Stability: Iron Dextran: IM injection use Z-track technique; IV test dose given over 5 minutes; subsequent doses given at a rate not to exceed 50 mg/minute or diluted in 250-1000 mL NS and infused over 1-6 hours. Iron Sucrose: Slow IV injection of 1 mL/minute (100 mg over 2-5 minutes); or infusion of 1 vial (100 mg/5 mL) in 100 mL NS over at least 90 minutes.

Pharmacology/Pharmacokinetics: Iron Dextran: The released iron, from plasma iron dextran, replenishes the depleted iron stores in bone marrow where it is incorporated into hemoglobin. Uptake of iron by the reticuloendothelial system is constant at about 10-20 mg/hour. Iron Sucrose: The reticuloendothelial system dissociates iron sucrose into iron and sucrose. The released iron increases serum iron concentrations and is incorporated into hemoglobin. Half-life elimination is approximately 6 hours.

Drug and Lab Interactions: Iron dextran may have decreased effect when administered with chloramphenicol. Iron sucrose may reduce absorption of oral iron preparations.

Contraindications/Precautions: Hypersensitivity to any component of the formulations and in anemia not associated with iron deficiency. Rare anaphylactic reactions have occurred during use, as well as hypotension. Use caution in patients with history of asthma, hepatic impairment, and rheumatoid arthritis when administering iron dextran. Iron dextran has a Pregnancy Category rating of C, iron sucrose is rated Pregnancy Category B.

Monitoring Parameters: Ferritin, hemoglobin, hematocrit, serum iron, transferrin

Adverse Effects: Both products have been associated with flushing, dizziness, metallic taste, and hypotension. Diaphoresis, urticaria, arthralgia, fever, chills, dizziness, headache, and nausea may be delayed 24-48 hours after IV administration or 3-4 days after IM administration.

As I discussed in the previous post, our son’s symptoms greatly improved on the Mayo protocol & we were extremely happy with his progress.  He even started attending 3/4 day of school in Sept 2015 (we attempted full day, but didn’t make it).  He was still far from his “normal” self and had symptoms that were affecting his ability to function normally, including low ferritin levels, exercise/activity intolerance, & fatigue.  With the exercise intolerance, he would still “crash” after too much activity (or too much activity intensity).  Crashes would include low-grade fever, increased fatigue, loss of appetite, & pallor.  These crashes usually lagged the activity by 12-24 hours (usually closer to 24 hours). Over several months, these crashes lessened in severity and length, but were still a part of our lives and limited his “normal” life functionality.  

Due to our son’s low white blood cell count (neutropenia) & low ferritin (iron) levels, we ended up seeing a hematologist near our home.  Turns out that this doctor had treated other POTS patients over the years. After attempting to increase our son’s ferritin levels with over-the-counter & then prescription iron without much success (for some reason his body just won’t absorb it well orally), we decided to start IV iron treatments with an iron sucrose called Venofer.

Why are adequate ferritin levels important for the body?  Ferritin serves to store iron in a non-toxic form, to deposit it in a safe form, and to transport it to areas where it is required in the body.  Iron is essential for proper oxygenation of the body.  Low ferritin levels cause increased fatigue and other problems.                                                                                                                                                                                                                                                                                                                                                            

When we initially tested our son’s ferritin in March 2015, it was 19.  His low ferritin level was definitely contributing to his fatigue.  Using over-the-counter & prescription iron supplements from March to September, Jack’s ferritin increased to 30.  Once we started the Venofer infusions (he had 4 infusions from Sept - Dec 2015), his ferritin levels jumped way up and amazing things happened!  He had increased energy & stamina (much less fatigue!) and he was able to increase his exercise and activity levels.  His appetite and taste for food also improved.  Over several months, his low white blood count normalized (less inflammation with proper oxygenation of the body).  Amazingly, he was even able to start attending some hockey practices and games.  However, he still experienced some exercise intolerance with overexertion, but these crashes were even less severe.