Iron deficiency anaemia
322mg once daily.
200mg once daily.
Liquid preparations should only be used when patients cannot tolerate or use solid formulations.
10ml daily.
10ml once daily.
Prescribing Notes:
- The haemoglobin should rise by approximately 1-2g/litre (100-200mg/100ml) per day or 20g/litre (2g/100ml) over 3-4 weeks. Once it has reached reference range, treatment should be continued for a further 3 months in order to replenish iron stores, and then stopped.
- Gastro-intestinal side-effects are common. Therefore, although iron preparations are best absorbed on an empty stomach they may be taken after food to reduce these side-effects.
- Modified-release preparations have no therapeutic advantage and should not be used.
- Vitamin C in the form of orange juice aids absorption of iron and may also counteract constipation caused by iron preparations.
- Due to reduced absorption patients should be advised to avoid taking tea, coffee, antacids and milk at the same time as iron.
- Liquid formulations of iron should only be used for treatment of iron deficiency in children or in adults unable to swallow tablets or in those not able to tolerate tablet/capsule formulations.
History Notes
20/04/2023
East Region Formulary content agreed.
Follow speciality guidelines or protocols for brand and preparation information.
By slow intravenous infusion, calculated according to body weight and iron deficit (consult product literature).
By slow intravenous infusion, calculated according to body weight and iron deficit (consult product literature).
See prescribing notes for more information on Ferric derisomaltose formulations.
By intravenous injection or infusion, calculated according to body-weight and iron deficit (consult product literature).
By intravenous injection or infusion, calculated according to body-weight and iron deficit (consult product literature).
By intravenous injection or infusion, calculated according to body-weight and iron deficit (consult product literature).
Dose as per specialist.
Dose as per specialist.
Prescribing Notes:
- The only valid reason for administering iron parenterally is non-tolerance of oral therapy. If oral preparations are taken reliably and are absorbed, the haemoglobin response is not significantly faster with the parenteral route.
- Intravenous administration of iron should only be undertaken in a secondary care setting.
- Prescribing, dosing, administration and safety information varies for IV iron products therefore care should be taken to consult the relevant individual product literature and monograph before and during use. Facilities for cardiopulmonary resuscitation should be available.
- Ferric carboxymaltose (Ferinject) is approved by SMC for the treatment of iron deficiency when oral iron preparations are ineffective or cannot be used and the diagnosis must be based on laboratory tests. This use is restricted to administration by intravenous infusion within the licensed indication but excluding use in patients receiving haemodialysis.
- Ferric derisomaltose Pharmacosmos 100mg/ml (previously named Monofer) is only approved for administration by high dose infusion. Administration by intravenous injection or to haemodialysis patients is outwith the Scottish Medicines Consortium advice.
- Ferric derisomaltose 100mg/2ml (Diafer) is approved for the treatment of iron deficiency in adults with chronic kidney disease (CKD) on dialysis, when oral iron preparations are ineffective or cannot be used.
- Ferric derisomaltose was previously named iron (III) isomaltoside 1000.
- Ferric carboxymaltose requires only a 15-minute administration time. A maximum dose of 1000mg of Ferinject can be administered per day. If the required dose is greater than 1000mg, a second dose at least one week later may be required.
- For parenteral treatment of iron deficiency anaemia in CKD patients, refer to local board guidelines or Anaemia in CKD guidance in the Edinburgh Renal Unit Handbook.
- Ferric carboxymaltose has been associated with risk of symptomatic hypophosphataemia leading to osteomalacia and fractures. For further advice see MHRA Drug safety Update, November 2020.
- Prescribers of parenteral iron preparations should be aware of advice issued by the MHRA, see MHRA Drug Safety Update, December 2014.
History Notes
13/11/2023
Formulation details and prescribing information updated for ferric derisomaltose.
20/04/2023
East Region Formulary content agreed.
The management of established iron overload involves venesection.
For prevention in patients receiving regular long-term blood transfusion. Hospital use only.
Consult product literature and local protocols.
Consult product literature and local protocols.
For specialist use in patients with rare acquired or inherited anaemias requiring recurrent blood transfusions. Hospital use only.
Oral use, dose adjusted according to serum-ferritin concentration and amount of transfused blood – consult product literature.
Oral use, dose adjusted according to serum-ferritin concentration and amount of transfused blood – consult product literature.
Oral use, dose adjusted according to serum-ferritin concentration and amount of transfused blood – consult product literature.
Prescribing Notes:
- Desferrioxamine may be used to manage transfusional iron overload.
- Deferasirox is approved for restricted use by a hospital specialist for the following indications:
- Management of chronic iron overload in rare acquired or inherited anaemias (thalassaemias) requiring recurrent blood transfusions.
- Treatment of chronic iron overload due to blood transfusions when desferrioxamine therapy is contraindicated or inadequate, with rare acquired or inherited anaemias. To be used in patients with myelodysplastic syndrome with an International Prognostic Scoring System score of low or intermediate -1 risk.
History Notes
20/04/2023
East Region Formulary content agreed.
Prescribing Notes:
- A pathway containing general notes on prescribing in pregnancy is available on the Pregnancy condition page of the formulary.
- Iron supplementation is currently under review, guidelines to follow.
History Notes
20/04/2023
East Region Formulary content agreed.
THERAPEUTIC:
Neonate: up to 2.5ml twice daily, smaller doses to be used initially.
1-11 months: up to 2.5ml twice daily, smaller doses to be used initially.
1-4 years: 2.5ml 3 times a day.
5-11 years: 5ml 3 times a day.
12-17 years: 5ml 3 times a day, increased to 10ml 3 times a day, dose to be increased gradually.
PROPHYLAXIS:
Neonate – 11 months: 1ml daily, prophylactic iron supplementation may be required in babies of low birth-weight who are solely breast-fed; supplementation is started 4-6 weeks after birth and continued until mixed feeding is established.
Therapeutic dose - 6-17 years 200mg 2-3 times daily.
Therapeutic dose - 12-17 years 210mg 2-3 times daily.
Therapeutic dose - 12-17 years 280mg twice daily.
Prescribing Notes:
- Iron salts should be given orally unless there are good reasons for using another route.
- The haemoglobin should rise by approximately 1-2g/litre (100-200mg/100ml) per day or 20g/litre (2g/100ml) over 3-4 weeks. Once it has reached reference range, treatment should be continued for a further 3 months in order to replenish iron stores, and then stopped. Therefore total treatment is often needed for 4-6 months.
- Gastro-intestinal side-effects are common and are often dose-related. Therefore although iron preparations are best absorbed on an empty stomach they may be taken after food to reduce these side-effects. If side-effects are problematic the dose can be reduced in the first instance or an alternative preparation prescribed.
History Notes
10/06/2020
Content migrated from LJF website.
Gastroenterology
By slow intravenous infusion, calculated according to body weight and iron deficit. (Consult product literature.)
By slow intravenous infusion, calculated according to body weight and iron deficit. (Consult product literature.)
For Child (body-weight up to 67kg)
Dose calculated according to body-weight and iron deficit, each divided dose should not exceed 3mg/kg/dose (consult product literature).
Child (body-weight 67kg and above)
Dose calculated according to body-weight and iron deficit, each divided dose should not exceed max. 200mg/dose (consult product literature).
Prescribing Notes:
- Parenteral iron is rarely used in children but may be administered to those with chronic renal failure who are receiving haemodialysis, or where there are problems with compliance or tolerability of oral therapy.
- If oral preparations are taken reliably and are absorbed, the haemoglobin response is not significantly faster with the parenteral route.
History Notes
10/06/2020
Content migrated from LJF website.
Prescribing Notes:
- Desferrioxamine (deferoxamine) is used for prevention in patients receiving regular long-term blood transfusion. This type of management requires specialist input but it may be prescribed by hospital specialists for administration at home.
- Deferasirox is approved for specialist use in patients >6 years old with thalassaemia who are transfusion dependent and iron overloaded.
History Notes
10/06/2020
Content migrated from LJF website.