Safety and efficacy of rapidly administered (one hour) one gram of low molecular weight iron dextran (INFeD) for the treatment of iron deficient anemia

Oral iron is a standard treatment of iron deficient anemia despite high rates of intolerance and nonadherence and may not replenish iron stores rapidly enough to meet ongoing losses [1]. Intravenous (IV) iron has advantages but remains underutilized. Whereas most formulations of IV iron require multiple doses for replacement, low molecular weight iron dextran (LMW ID) may be administered as a total dose infusion, typically over a 4- to 6-hr period [2,3]. A 4-hr infusion for doses up to 4 g was standard in our practice until 2 years ago. However, clinical studies suggest that 1 g of IV iron is an adequate dose for many patients [3-5], and it became apparent that we were frequently infusing doses of at least 1 g in 1 hr without evidence of significant adverse events [3]. Now, our clinical practice routinely infuses 1 g of LMW ID in 250 mL normal saline over 1 hr without premedication as our standard practice. We summarize our experience with the safety and efficacy of this method of administering IV iron in unselected patients with iron deficiency.