Feature Articles

Are Iron Injections Right for You?

July 2, 2009

Nurse with IV bag

You may have heard iron injections referred to as iron shots, IV iron, parenteral iron or IM iron. Iron injections are generally given to patients with a severe iron deficiency to make sure their body has enough iron to make healthy red blood cells. To find out if iron injections can help you feel better, talk with your doctor about your symptoms, medical history and any current treatments you are receiving for iron deficiency or anemia. To prepare you for a discussion with your doctor, this article includes information about iron injections and treating iron deficiency and anemia.

Iron in Your Body

Iron is an important component in your body which helps your red blood cells move oxygen to your muscles and organs. However, without an ample and steady supply of iron in your diet, iron deficiency and iron deficiency anemia can develop. These conditions can make you feel tired, weak or dizzy. If these symptoms are related to anemia, eating a nutritious diet including meat, leafy green vegetables and iron-fortified grains may be all you need to help you feel better. Read more about getting the recommended amount of iron in your diet in Anemia and Nutrition: The Importance of Iron.

Other times, though, your body may not be absorbing iron properly or your body may need a lot more iron to make enough red blood cells. If this is the case, you may need to receive additional iron either as an iron pill taken orally or an iron injection.

Ferrous Oral Iron Supplements
Iron Supplement Tablet Size Elemental Iron
Ferrous fumarate 325 mg 108 mg
Ferrous sulfate 325 mg 65 mg
Ferrous gluconate 325 mg 35 mg
Fishbane S, et al. Kidney Int Suppl. 1999 Mar.2

Oral Iron Supplements

If your doctor determines that your body does not have enough iron or that you have an iron deficiency, he or she may recommend that you take an over-the-counter iron pill. There are several different forms of iron pills available at most drug stores and supermarkets, including the three forms of ferrous iron which are listed to the right. Be sure to follow the advice of your doctor when taking oral iron. You can also read more about iron pills in A Patient’s Guide to Oral Iron Supplements.

If you are currently taking oral iron, pay close attention to any side effects like an upset stomach or constipation. If these symptoms are severe enough to prevent you from taking your full prescribed dose, be sure to tell your doctor or healthcare professional. All iron supplements will cause your stool to become dark in color. If you are unable to take oral iron supplements or they are not effectively increasing your iron levels, your doctor might choose to give you an iron injection.

What is an iron injection?

Iron injections are liquid solutions containing iron which are either injected directly into the blood stream through an IV or into the muscle (IM) – often the upper arm. Unlike oral supplements, iron injections need to be administered at a hospital, clinic or doctor’s office by a trained professional.

Who can receive iron injections?

Iron injections are often given because patients are not able to take their full dose of oral iron or their body cannot properly absorb iron through their digestive tract. They may also be given to patients who have extremely low levels of iron or who have lost a large amount of blood.3 Because iron by injection does not have to be absorbed through the intestines, but is delivered directly to your circulatory system, it can help build red blood cells more quickly than oral iron.

Eligible for Iron Injections
  • Patients who are receiving erythropoiesis-stimulating agents (ESAs)
  • Patients in whom oral iron supplements were ineffective or not well-tolerated
  • Patients with significant blood loss

For anemic patients receiving drugs called erythropoiesis-stimulating agents (ESAs), iron injections are necessary to ensure that the body has an ample and steady supply of iron. “When you’re getting ESAs you are ramping up red blood cell production which increases the need for iron. To meet increased demand, you need to get IV iron,” said Dr. Allen Nissenson, chief medical officer at Davita, Inc.

Patients who are most often given these drugs to stimulate the production of red blood cells are those who have anemia caused by cancer chemotherapy treatment, kidney failure, drugs used to treat AIDS, or those who are scheduled to have surgery.4 Some elderly patients or patients with inflammatory bowel disease or rheumatoid arthritis may also benefit from iron injections and ESA treatment.5-7 Read more about ESAs in ESA Drugs Treat Anemia By Stimulating Red Blood Cell Production.

Types of Iron Injections

There are different types of solutions containing iron that can be injected into the circulatory system or muscle to raise iron levels in the body. Receiving these solutions is similar to other medications which are delivered intravenously through an IV or by a syringe. The appropriate type, amount and frequency of iron injections are determined for each individual patient based on the severity of their iron deficiency and their ability to tolerate the treatment. Iron injections include three major types: iron dextran, ferumoxytol and carbohydrate iron, which includes the forms ferric gluconate and iron sucrose.

Different Forms of Iron Injections
Generic Name Brand Name Injection Dosing Allergenic
Iron dextran INFed®
Dexferrum®
IV & IM
IV only
Large, single doses injected slowly <1% of patients may be allergic
Ferumoxytol Feraheme® IV only
Large, single doses injected quickly <1% of patients may be allergic
Ferric gluconate Ferrlecit® IV only Small, multiple doses No
Iron sucrose Venofer® IV only Small, multiple doses No
Watson Pharma, AMAG Pharmaceuticals, American Regent. Prescribing. (U.S.)8-12

Iron dextran – This iron solution is widely used by doctors because it can be given in a single, large dose. This means patients do not need to visit the doctor as often and may feel better more quickly than with other iron solutions. However, a small percentage of patients are allergic to this form of iron solution and may not be able to tolerate large doses or any size doses. An allergic reaction can cause patients to experience anaphylaxis, an anaphylactic reaction or even cause death, as described below in the description of side effects. Your doctor will first give you a small test dose to determine if you are allergic to this form of iron solution. Both test and full doses must always be given by your doctor or healthcare professional.

Ferumoxytol – This iron solution can be administered in similar-sized doses as iron dextran and can also be safely injected over a shorter time period. Generally, two intravenous doses are given to patients with the second dose coming 3 to 8 days after the first dose. This new form of iron injection was recently given approval by the U.S. Food and Drug Administration (FDA) and will be available for use in the second half of July 2009. Read more about the drug's release in the Anemia in the News section.

Possible Side Effects of Iron Injections
  • Anaphylaxis
  • Low blood pressure
  • Flushing
  • Headache
  • Muscle and joint pain
  • Dizziness
  • Nausea
  • Rashes
  • Pain and inflammation at the injection site
  • Fever
  • Chills

Ferric gluconate and iron sucrose – These two iron solutions are less likely to trigger an allergic reaction and cannot be given in large doses. Both forms are normally administered in a series of smaller doses given over a period of days or weeks.

Side Effects Caused by Iron Injections

Patients receiving iron injections can experience side effects, including flushing, headache, muscle and joint pain, dizziness, nausea, rashes, pain and inflammation at the injection site, fever or chills. Some patients may also experience a drop in blood pressure. Side effects may appear while you are receiving the injection or following completion of the injection. If you receive an iron injection, be sure to immediately report any of these or other side effects to your doctor or healthcare professional.

A very small percentage of patients who are allergic to iron dextran can experience anaphylaxis or an anaphylactic shock. Anaphylaxis will usually bring about hives that itch, flushed or pale skin, and can include a constriction of the airway, swelling of the tongue or throat, a weak and rapid pulse, nausea, vomiting, diarrhea, dizziness or fainting. These severe allergic reactions must be treated immediately in the emergency room or hospital.13 If untreated, anaphylaxis can lead to unconsciousness or death. Patients allergic to iron dextran will not be able to receive any size doses of the solution.

Managing Iron Doses

Once you have started treatment, your doctor will need to closely monitor how your body reacts to the iron injections. This means he or she will regularly measure your iron levels and hemoglobin levels to gauge how much iron is successfully being incorporated into your red blood cells. Depending on the status of your levels, your doctor may need to raise or lower the amount of solution you receive, and increase or decrease the number doses you receive each week or month.

For your safety and comfort, your doctor will also monitor any side effects you may experience as a result of the iron injections. Most notably, this means making sure you are not allergic to iron dextran by administering a small test dose prior to treatment. Once it can be determined if you are or are not allergic, regular iron injections can begin. Reporting side effects is very important to help your doctor make sure iron injections are safely and effectively treating your iron deficiency.

Iron deficiency occurs when the body is low in stored iron. It may not cause any symptoms and is often not recognized.

Iron deficiency anemia is a condition that develops when a low iron level persists and prevents the body from making enough healthy red blood cells. The body can make red blood cells, even when it has an iron deficiency, but eventually the shortage of stored iron can slow that process and cause anemia.

Read More About Iron Deficiency:
Information Handout

Are iron injections right for me?

Correctly diagnosing and treating an iron deficiency is an important step to feeling better, so it is essential that you discuss your symptoms with a doctor or medical professional to find out if iron injections are right for you. Normally, your doctor will recommend you take an oral iron supplement and continue to monitor the iron levels in your body. If your iron levels do not improve, treatment with iron injections may be an option.

Iron injections can be a helpful treatment for iron deficiency and anemia, but it may take a while for them to reach their full effect. “Iron deficiency itself can cause some symptoms and an iron injection may make you feel better right away. But it will take about 10-13 days for the full effects of improved red blood cell production to alleviate symptoms,” reported Dr. Nissenson.

Close communication with your doctor about your symptoms, medical history and side effects will help him or her provide the necessary treatments for iron deficiency and anemia.

References

  1. University of Maryland Medical Center. Blood Disorders: Anemias. Link. Accessed: June 24, 2009.
  2. Fishbane S, Mittal SK, Maesaka JK. Beneficial effects of iron therapy in renal failure patients on hemodialysis. Kidney Int Suppl. 1999 Mar;69:S67-70. Link.
  3. Burch B. The Eclectic Physician. IV iron infusion. Link. Accessed: June 16, 2009.
  4. U.S. Food and Drug Administration. Information for Healthcare Professionals. Erythropoiesis Stimulating Agents (ESAs). Link. Accessed: June 17, 2009.
  5. Trovarelli T, Kahn B, Vernon S. Transfusion-free surgery is a treatment plan for all patients. AORN J. 1998 Nov;68(5):773-88 Link.
  6. Gasché C, Dejaco C, Waldhoer T, Tillinger W, Reinisch W, Fueger GF, Gangl A, Lochs H. Intravenous iron and erythropoietin for anemia associated with Crohn disease. A randomized, controlled trial. Ann Intern Med. 1997 May 15;126(10):782-87. Link.
  7. Murphy EA, Bell AL, Wojtulewski J, Brzeski M, Madhok R, Capell HA. Study of erythropoietin in treatment of anaemia in patients with rheumatoid arthritis. BMJ. 1994 Nov 19;309(6965):1337-78. Link.
  8. Watson Pharma, Inc. INFeD (Iron Dextran Injection, USP) US prescribing information. Link. Accessed: June 17, 2009.
  9. American Regent. Dexferrum (Iron Dextran Injection, USP) US prescribing information. Link. Accessed: October 16, 2009.
  10. Watson Pharma, Inc. Ferrlecit (sodium ferric gluconate complex in sucrose injection) US prescribing information. Link. Accessed: June 17, 2009.
  11. Food and Drug Administration. Feraheme (ferumoxytol) US prescribing information. Link. Accessed: July 7, 2009.
  12. American Regent. Venofer (Iron Sucrose Injection, USP) US prescribing information. Link. Accessed: June 17, 2009.
  13. Mayo Clinic. Diseases and Conditions: Anaphylaxis. Link. Accessed: June 16, 2009.