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Iron Dextran

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Also known as: 9004-66-4, Iron-dextran, Sulfuric acid, iron salt, Iron;sulfuric acid, Fero gradumet, 10124-49-9

Molecular Formula

FeH₂O₄S

Molecular Weight

153.93 g/mol

InChI Key

MVZXTUSAYBWAAM-UHFFFAOYSA-N

A complex of ferric oxyhydroxide with dextrans of 5000 to 7000 daltons in a viscous solution containing 50 mg/ml of iron. It is supplied as a parenteral preparation and is used as a hematinic. (Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed, p1292)

1 2D Structure

Iron Dextran

2 Identification

2.1 Computed Descriptors

2.1.1 IUPAC Name

iron;sulfuric acid

2.1.2 InChI

InChI=1S/Fe.H2O4S/c;1-5(2,3)4/h;(H2,1,2,3,4)

2.1.3 InChI Key

MVZXTUSAYBWAAM-UHFFFAOYSA-N

2.1.4 Canonical SMILES

OS(=O)(=O)O.[Fe]

2.2 Synonyms

2.2.1 MeSH Synonyms

1. Dexferrum

2. Dextran Iron Complex

3. Dextran-iron Complex

4. Dextrofer

5. Feosol

6. Ferridextran

7. Hematran

8. Icar

9. Imfergen

10. Imferon

11. Imperon

12. Imposil

13. Infed

14. Iron Dextran Complex

15. Iron-dextran Complex

16. Norferan

2.2.2 Depositor-Supplied Synonyms

1. 9004-66-4

2. Iron-dextran

3. Sulfuric Acid, Iron Salt

4. Iron;sulfuric Acid

5. Fero Gradumet

6. 10124-49-9

7. Sulfuric Acid, Iron(3+) Salt (3:2)

8. Conferon

9. Sulfuric Acid Iron Salt (1:1)

10. Slow-fe

11. Sulfuric Acid Iron(2+) Salt (1:1)

12. Sulphuric Acid, Iron Salt

13. Wln: Fe S-o4

14. Fe Dextran

15. Sulfuric Acid, Iron Salt (1:?)

16. Einecs 233-336-3

17. Iron Dextran Solution

18. Sulfuric Acid--iron (1/1)

19. Dtxsid80906016

20. Nsc57631

21. Nsc146177

22. S6987

23. Akos030243004

24. Ft-0624534

2.3 Create Date

2005-08-08

3 Chemical and Physical Properties

Molecular Formula	FeH₂O₄S
Molecular Weight	153.93 g/mol
Hydrogen Bond Donor Count	2
Hydrogen Bond Acceptor Count	4
Rotatable Bond Count	0
Exact Mass	153.902315 g/mol
Monoisotopic Mass	153.902315 g/mol
Topological Polar Surface Area	83 Å²
Heavy Atom Count	6
Formal Charge	0
Complexity	81.3
Isotope Atom Count	0
Defined Atom Stereocenter Count	0
Undefined Atom Stereocenter Count	0
Defined Bond Stereocenter Count	0
Undefined Bond Stereocenter Count	0
Covalently Bonded Unit Count	2

4 Drug and Medication Information

4.1 Therapeutic Uses

Hematinics

National Library of Medicine's Medical Subject Headings. Iron Dextran. Online file (MeSH, 2015). Available from, as of May 1, 2015: https://www.nlm.nih.gov/mesh/2014/mesh_browser/MBrowser.html

/CLINICAL TRIALS/ ClinicalTrials.gov is a registry and results database of publicly and privately supported clinical studies of human participants conducted around the world. The Web site is maintained by the National Library of Medicine (NLM) and the National Institutes of Health (NIH). Each ClinicalTrials.gov record presents summary information about a study protocol and includes the following: Disease or condition; Intervention (for example, the medical product, behavior, or procedure being studied); Title, description, and design of the study; Requirements for participation (eligibility criteria); Locations where the study is being conducted; Contact information for the study locations; and Links to relevant information on other health Web sites, such as NLM's MedlinePlus for patient health information and PubMed for citations and abstracts for scholarly articles in the field of medicine. Iron dextran is included in the database.

NIH/NLM; ClinicalTrials.Gov. Available from, as of July 18, 2015: https://clinicaltrials.gov/search/intervention=iron+dextran

Intravenous or intramuscular injections of INFeD are indicated for treatment of patients with documented iron deficiency in whom oral administration is unsatisfactory or impossible. /Included in US product labeling/

NIH; DailyMed. Current Medication Information for INFed (Iron Dextran) Injection (Updated: July 2014). Available from, as of July 21, 2015: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=abacb7fa-2fc2-471e-9200-944eeac8ca2a

MEDICATION (VET): Nutritional factor (parenteral). Used in iron deficiency anemia, chiefly in pigs.

O'Neil, M.J. (ed.). The Merck Index - An Encyclopedia of Chemicals, Drugs, and Biologicals. Cambridge, UK: Royal Society of Chemistry, 2013., p. 948

For more Therapeutic Uses (Complete) data for IRON DEXTRAN (8 total), please visit the HSDB record page.

4.2 Drug Warning

/BOXED WARNING/ WARNING: RISK FOR ANAPHYLACTIC-TYPE REACTIONS. Anaphylactic-type reactions, including fatalities, have followed the parenteral administration of iron dextran injection. Have resuscitation equipment and personnel trained in the detection and treatment of anaphylactic-type reactions readily available during INFeD administration. Administer a test INFeD dose prior to the first therapeutic dose. If no signs or symptoms of anaphylactic-type reactions follow the test dose, administer the full therapeutic INFeD dose. During all INFeD administrations, observe for signs or symptoms of anaphylactic-type reactions. Fatal reactions have followed the test dose of iron dextran injection. Fatal reactions have also occurred in situations where the test dose was tolerated. Use INFeD only in patients in whom clinical and laboratory investigations have established an iron deficient state not amenable to oral iron therapy. Patients with a history of drug allergy or multiple drug allergies may be at increased risk of anaphylactic-type reactions to INFeD.

Abdominal pain, dyspepsia, nausea, vomiting, diarrhea, metallic taste in the mouth, altered taste, and transient loss of taste perception have occurred in patients receiving iron dextran.

American Society of Health-System Pharmacists 2015; Drug Information 2015. Bethesda, MD. 2015, p. 1447

Anaphylactic or anaphylactoid reactions to iron dextran, including fatal anaphylaxis, have been reported. These reactions occur most frequently within the first several minutes of administration and are generally characterized by sudden onset of respiratory difficulty (e.g., wheezing, bronchospasm, rigor, dyspnea, cyanosis), tachycardia, hypotension, respiratory arrest, and/or cardiovascular collapse. The manufacturers state that concomitant use of angiotensin-converting enzyme (ACE) inhibitors may increase the risk for reactions to iron dextran. The level of risk for anaphylactic-type reactions following exposure to specific iron dextran preparations is not known and may vary. Iron dextran preparations differ in chemical characteristics and may differ in clinical effects; the manufacturers state that such preparations are not clinically interchangeable. Acute hypersensitivity reactions to iron dextran have been estimated to occur in 0.2-3% of patients. These reactions have been reported after administration of uneventful test doses of iron dextran as well as after therapeutic doses of the drug. Although it has been suggested that severe systemic reactions, including anaphylactoid reactions, are more common following IV rather than IM administration of iron dextran, the risk of severe systemic reactions following IV or IM administration has not been directly compared and there appears to be no well-substantiated evidence of a difference in the frequency of anaphylactoid reactions following either route of administration.

American Society of Health-System Pharmacists 2015; Drug Information 2015. Bethesda, MD. 2015, p. 1447

Large IV doses of iron dextran, such as those used in total-dose infusions, may be associated with an increased frequency of adverse effects, especially delayed (1-2 days) reactions manifested by arthralgia, backache, myalgia, adenopathy, moderate to high fever, backache, chills, dizziness, headache, malaise, nausea, and/or vomiting. The onset of these adverse effects is usually 24-48 hours after administration of the drug, and the effects generally subside within 3-4 days. Delayed adverse effects have also occurred following IM administration and usually subsided within 3-7 days. The etiology of delayed adverse effects is not known, but the symptom complex resembles that of a serum sickness reaction. Patients with rheumatoid arthritis and possibly other inflammatory diseases (e.g., ankylosing spondylitis, lupus erythematosus) may be at particular risk for delayed reactions. IV administration of iron dextran has caused fever and exacerbation or reactivation of joint pain and swelling in patients with rheumatoid arthritis; in addition, exacerbation of ankylosing spondylitis in one patient and arthralgia, myalgia, erythema nodosum, and fever in a patient with lupus erythematosus have been reported. Such exacerbations of underlying inflammatory conditions may respond to nonsteroidal anti-inflammatory agent (NSAIA) therapy and may be prevented with corticosteroid pretreatment.

American Society of Health-System Pharmacists 2015; Drug Information 2015. Bethesda, MD. 2015, p. 1447

For more Drug Warnings (Complete) data for IRON DEXTRAN (21 total), please visit the HSDB record page.

4.3 Drug Indication

For treatment of patients with documented iron deficiency in whom oral administration is unsatisfactory or impossible. Also used to replenish body iron stores in Non-Dialysis Dependent-Chronic Kidney Disease (NDD-CKD) patients receiving or not receiving erythropoietin and in Hemodialysis Dependent (HDD-CKD) and Peritoneal Dialysis Dependent (PDD-CKD) - Chronic Kidney Disease patients receiving an erythropoietin.

5 Pharmacology and Biochemistry

5.1 Pharmacology

Iron dextran is a dark brown, slightly viscous sterile liquid complex of ferric hydroxide and dextran for intravenous or intramuscular use. It is for treatment of patients with documented iron deficiency in whom oral administration is unsatisfactory or impossible. Iron is essential to the formation of hemoglobin and to the function and formation of other heme and nonheme compounds. Untreated depletion of iron stores leads to iron-deficient erythropoiesis and, in turn, to iron deficiency anemia.

5.2 MeSH Pharmacological Classification

Hematinics

Agents which improve the quality of the blood, increasing the hemoglobin level and the number of erythrocytes. They are used in the treatment of anemias. (See all compounds classified as Hematinics.)

5.3 FDA Pharmacological Classification

5.3.1 Pharmacological Classes

Parenteral Iron Replacement [EPC]; Phosphate Binder [EPC]; Phosphate Chelating Activity [MoA]; Iron [CS]

5.4 Absorption, Distribution and Excretion

Absorption

The major portion of intramuscular injections of iron dextran is absorbed within 72 hours; most of the remaining iron is absorbed over the ensuing 3 to 4 weeks.

Route of Elimination

Dextran, a polyglucose, is either metabolized or excreted.

Following intramuscular administration, iron dextran is absorbed from the site of injection primarily through the lymphatic system. Absorption takes place in two stages. Approximately 60% of the dose or iron dextran inected is absorbed within 72 hours of administration. Ninety percent of the dose is absorbed in the second, slower, phase lasting approximately 1 to 3 weeks in duration. The remaining 10% of the dose is gradually absorbed over a period of several months or longer.

Health Canada; Product Monograph for Dexiron (Iron Dextran Injection, USP (50 mg Elemental Iron/mL) 1 mL, 2 ml Single-Dose Vials), Drug Identification Number (DIN): 02205963 p.16 (Date of Revision: January 2, 2013). Available from, as of July 21, 2015: https://webprod5.hc-sc.gc.ca/dpd-bdpp/start-debuter.do?lang=eng

Following IM or IV injection, iron dextran is gradually cleared from plasma by reticuloendothelial cells of liver, spleen, and bone marrow. Results of several studies indicate that /a/ variable portion of IV dose... may be stored in unusable form in bone marrow.

American Society of Health-System Pharmacists 2015; Drug Information 2015. Bethesda, MD. 2015, p. 1448

In vitro studies have shown that removal of iron dextran by dialysis is negligible.

NIH; DailyMed. Current Medication Information for INFed (Iron Dextran) Injection (Updated: July 2014).

/MILK/ Traces of unmetabolized iron dextran are excreted in human milk.

For more Absorption, Distribution and Excretion (Complete) data for IRON DEXTRAN (6 total), please visit the HSDB record page.

5.5 Metabolism/Metabolites

Dextran, a polyglucose, is either metabolized or excreted.

Dextran, a polyglucose, is either metabolized or excreted. Only traces of unmetabolized iron dextran are excreted in the urine, bile or feces.

American Society of Health-System Pharmacists 2015; Drug Information 2015. Bethesda, MD. 2015, p. 1448

5.6 Biological Half-Life

5 hours (some indications that it can be as long as 10 hours)

After intravenous injection of 2 mL of DexIron (100 mg iron) to renal dialysis patients ... the average half-life of iron dextran in serum was 58.9 hours, ranging from 9.4 to 87.4 hours in 20 patients.

Various studies involving intravenously administered (59)Fe iron dextran to iron deficient subjects, some of whom had coexisting diseases, have yielded half-life values ranging from 5 hours to more than 20 hours. The 5-hour value was determined for (59)Fe iron dextran from a study that used laboratory methods to separate the circulating (59)Fe iron dextran from the transferrin-bound (59)Fe. The 20-hour value reflects a half-life determined by measuring total (59)Fe, both circulating and bound. It should be understood that these half-life values do not represent clearance of iron from the body. Iron is not easily eliminated from the body and accumulation of iron can be toxic.

5.7 Mechanism of Action

After iron dextran is injected, the circulating iron dextran is removed from the plasma by cells of the reticuloendothelial system, which split the complex into its components of iron and dextran. The iron is immediately bound to the available protein moieties to form hemosiderin or ferritin, the physiological forms of iron, or to a lesser extent to transferrin. This iron which is subject to physiological control replenishes hemoglobin and depleted iron stores.

... Circulating iron dextran is removed from the plasma by cells of the reticuloendothelial system, which split the complex into its components of iron and dextran. The iron is immediately bound to the available protein moieties to form hemosiderin or ferritin, the physiological forms of iron, or to a lesser extent to transferrin. This iron which is subject to physiological control replenishes hemoglobin and depleted iron stores.

NIH; DailyMed. Current Medication Information for INFed (Iron Dextran) Injection (Updated: July 2014).

... The toxicity of iron in biological systems is believed to be attributed to its ability to catalyze the generation of oxygen-free radicals. In the current investigation, the dose-dependent effects of chronic iron-loading on heart tissue concentrations of iron, glutathione peroxidase (GPx) activity, free-radical production, and cardiac dysfunction were investigated in a murine model of iron-overload cardiomyopathy. It was shown that chronic iron-overload results in dose-dependent (a) increases in myocardial iron burden, (b) decreases in the protective antioxidant enzyme GPx activity, (c) increased free-radical production, and (d) increased mortality. These findings show that the mechanism of iron-induced heart dysfunction involves in part free radical-mediated processes.

PMID:11232511 Bartfay WJ, Bartfay E; Biol Res Nurs 2 (1): 49-59 (2000)

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