St. Peter W, Lambrecth LJ, Macres M
Randomized cross-over study of adverse reactions and cost implications
of intravenous push compared with infusion of iron dextran in
Am J Kidney Dis
(Oct) 28:523-528 1996
The package insert for parenteral iron dextran recommends administration by
IV push at a rate not to exceed 50 ml/min. There has been a sense at some
centers that the potential for adverse reactions could be decreased by
diluting the drug and administering it slowly by IV infusion. This report
details a study comparing these two methods of drug administration.
Ten patients were given iron dextran intravenously either as a 100 mg IV
over two minutes, or as an infusion mixed in 50 ml of normal saline over 30
minutes by an infusion pump. The study lasted for 4 consecutive treatments.
On each subsequent treatment day, the method of administration was
alternated, creating an effective cross over study design. Seven patients
completed the four dose study. No differences were found between the methods
in blood pressure, pulse, or adverse events. In addition, there was no
difference in nursing time, or the number of needles and syringes used. The
only significant cost difference was related to the use of IV tubing and a
piggyback set for the infusion method. The authors concluded that
push is as safe and, and is cost effective compared to infusion of iron
Comment: This was a very small study, involving few patients studied
short time period. Nonetheless, I think the results confirm to some extent
the relative safety and cost effectiveness of the IV push method. There is
really no biologic reason to expect dilution to lower the risk of adverse
events. Most significant reactions to IV iron dextran are due to direct
release of mediators from mast cells. The stimulus for release is not known.
One theory is that some vials of iron dextran contain a small quantity of
free iron which leads to degranulation. Whether the reactions are true
anaphylaxis, or related to free iron, IV push should not lead to a greater
risk for reactions.
(Stephen Fishbane, M.D., Winthrop University Hospital, Mineola,