Sunder-Plassman G, Horl WH
Safety of intravenous injection of iron saccharate in
haemodialysis patients
Nephrol Dial Transplant
(Sep) 11:1797-1802 1996

This paper describes the use of IV iron saccharate in dialysis patients. The
full text of this
abstract is available from Oxford Press at this
site.
Comment: The safety of the intravenous administration of iron
is becoming an important clinical issue as these preparations are
being used more frequently. Adverse reactions to these compounds may
be caused by allergy, or as a result of dissociation of free iron
from the parent drug. The dextran portion of the iron dextran
molecule probably renders this drug the most likely of intravenous
formulations to cause allergy. We recently participated in a 4 center
study evaluating the safety of intravenous iron dextran, and found
anaphylactoid type reactions to occur in 1.7% of patients
treated (Am J Kidney Dis, in press 10/96). While the low
incidence of reactions was reassuring, an ideal iron therapy would
cause no such reactions.
Iron dextran binds iron more tightly than any other iron compound, and
therefore cause very few reactions due to the dissociation of free
iron. The other two intravenous iron compounds in common use in Europe
are ferric gluconate and iron saccharate. It is likely that allergic
reactions would be less common with these agents compared to iron
dextran, because they lack dextran chains. However, both bind iron
less tightly than iron dextran, and may cause reactions on this basis.
This is especially true for ferric gluconate, as evidenced by physical
chemistry studies by Geisser et al, and by a recent clinical study by
Zanen et al (Nephrol Dial Transplant 11:820-824, 1996).
Chemical studies indicate that iron saccharate may bind iron more
tightly than ferric gluconate, while potentially avoiding allergic
reactions seen with iron dextran.
This study by Sunder-Plassman and Horl sought to evaluate the safety
of iron saccharate. It is the most recent of a series of
investigations by these authors utilizing iron saccharate. The
investigators have demonstrated that at doses of up to 100 mg of iron
saccharate given rapidly IV, there is little evidence to suggest
excessive release of free iron. This is an important finding which
confirms the promising nature of this drug. There continues to be a
great need for randomized trials comparing the various intravenous
iron preparations with regard to efficacy, safety and cost.
(Stephen Fishbane, M.D., Winthrop University Hospital, Mineola, NY)