Dextran 40 Dosage and Administration
- Administration IV Administration For solution and drug compatibility information, see Compatibility under Stability. Administer by IV infusion. Preservative-free, single-use container; discard unused portion. ...
- Dosage Pediatric Patients Shock IV ...
- Prescribing Limits Pediatric Patients Shock IV ...
- Special Populations Hepatic Impairment No specific dosage recommendations at this time. (See Hepatic Effects under Cautions.) ...
Where do you inject iron dextran?
Iron dextran injection comes as a solution (liquid) to inject into the muscles of the buttocks or intravenously (into a vein) by a doctor or nurse in a medical facility.
How long do you administer iron dextran?
Patients should be monitored for anaphylaxis and hypersensitivity reactions for 1 hour following the administration of a 25 mg (0.5 mL) test dose. Test doses should be administered over 1 to 2 minutes.
How fast do you infuse iron dextran?
INFeD is given undiluted at a slow gradual rate not to exceed 50 mg (1 mL) per minute.
How do you administer parenteral iron dextran?
Parenteral iron can be administered via the intramuscular or intravenous route either directly or as an additive to total parenteral nutrition. Both routes of administration can cause various side effects and a test dose is recommended before therapeutic administration to assess the risk for anaphylaxis.
How fast can you run iron IV?
Infusion times range from less than 20 minutes to up to 4 hours. Iron infusion side effects vary depending on which form is being used. Side effects like nausea and low blood pressure are common with most iron infusions.
How do you administer an iron infusion?
A doctor or nurse will use a needle to place a small tube, known as a catheter, into a vein. The catheter is generally put into a vein in the hand or arm. Then, the doctor or nurse will remove the needle, leaving the catheter in the vein. The catheter is connected by a tube to an IV bag of iron.
What is iron dextran intravenous?
Iron dextran is an iron replacement product that is used to treat iron deficiency, such as anemia (not enough iron in the blood) or blood loss in patients with certain conditions (eg, hemophilia, gastrointestinal bleeding).
When do you use iron dextran?
Iron dextran is used to treat iron deficiencies and iron deficiency anemia (low red blood cells).
How long does an iron infusion take?
An iron infusion can take up to 3 or 4 hours. You should expect to remain seated for this time. In some cases, the infusion may take a little longer, depending on the level of treatment your doctor thinks you need. The slow infusion rate helps prevent complications.
Can iron dextran be mixed with normal saline?
The intravenous solution to be used is normal saline. DEXTROSE AND WATER SHOULD NEVER BE USED TO ADMINISTER IRON DEXTRAN! The frequency of adverse reactions is substantially higher when D5W is used instead of normal saline.
Can iron be given by im injection?
The total dose of intramuscularly given iron element ranged from 750 to 2,000 mg. The injections did not cause either local pain or systemic reactions, but did result in reticulocytosis and rise in hemoglobin level.
When do you give oral iron or IV iron?
Oral iron has the advantage of being simple and cheap, but it is limited by side-effects, poor compliance, poor absorption, and low efficacy. Intravenous iron is the best means of guaranteeing delivery of readily available iron to the bone marrow, but it requires greater clinical supervision.
How long does an iron infusion take?
An iron infusion can take up to 3 or 4 hours. You should expect to remain seated for this time. In some cases, the infusion may take a little longer, depending on the level of treatment your doctor thinks you need. The slow infusion rate helps prevent complications.
How often can you get iron dextran?
If no reaction is seen after one hour, the full dose may be given. You will be checked carefully for reactions by a health care worker each time you are getting the iron. Iron injections may be given once daily in small doses or as directed by your doctor.
How long does it take iron injections to work?
How long after my iron infusion will I start to feel better? Your iron levels will be restored directly right after the infusion, however, it can take up to two weeks before you start to notice a difference and feel better.
When do you use iron dextran?
Iron dextran is an iron replacement product that is used to treat iron deficiency, such as anemia (not enough iron in the blood) or blood loss in patients with certain conditions (eg, hemophilia, gastrointestinal bleeding).
Before Taking This Medicine
You should not receive iron dextran if you are allergic to it, or if you have a type of anemia that is not caused by iron deficiency.To make sure i...
How Is Iron Dextran given?
Iron dextran is injected into a vein through an IV. You may be shown how to use an IV at home. Do not self-inject this medicine if you do not under...
What Happens If I Overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.Overdose symptoms may include joint pain, chills, dizziness, fever,...
Iron Dextran Side Effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue,...
What Other Drugs Will Affect Iron dextran?
Other drugs may interact with iron dextran, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your...
What is dextran used for?
Dextran is a medication used in managing and treating various clinical conditions, including during hemorrhage, shock, surgical procedures, radiological imaging, antithrombotic administration, and ophthalmic relief of xerophthalmia. This activity reviews the indications, contraindications, adverse events, mechanisms of action, toxicity, and other key factors of dextran therapy in the clinical setting related to the essential information needed by members of a professional healthcare team in the treatment and management involved in patient care with the related conditions.
Why do microsurgeons use dextran?
Microsurgeons can use dextran to decrease the risk of vascular complications such as thrombosis. [6] This mechanism occurs via the antithrombotic effects of dextran binding to platelets, erythrocytes, and the vascular endothelium to decrease aggregation and adhesiveness.[7] Dextran reduces Von Willebrand factor to decrease the function of platelets.[8] It also activates plasminogen and prolongs bleeding time. These effects increase proportionally with the increase in the molecular weight of the dextran.
What is TC99M dextran?
Technetium Tc99m-labeled dextran by intravenous administration is a blood vascular imaging agent for the diagnosis of pericardial effusion, ventricular aneurysms, or bleeds.
Does dextran prolong bleeding?
Since dextran can prolong bleeding time and is antithrombotic, it is important to monitor its usage.[8] While it reduces emboli and adhesion of platelets, dextran effects increase proportionally with the molecular weight of the dextran administered. It is best to avoid exceeding the dosage recommended due to excess wound bleeding, melena, wound seroma, and volume overload. As dextran may negatively impact renal function, one should carefully watch for oliguria or anuria as a harbinger of renal failure.[10] Monitoring for serious systemic allergic reactions is also crucial, as elaborated upon previously.
Is dextran safe for heart failure?
It is relatively contraindicated in patients with untreated bleeding disorders, including platelet dysfunction, because of increased bleeding risk. Caution should be exercised in patients with heart failure, as rapid administration may prove dangerous due to the plasma volume expansion effects, potentially leading to circulatory overload and acute decompensation. However, even slower but continued administration may pose some risk as it may reduce plasma protein levels, which can reduce oncotic pressure and worsen edema. If volume overload occurs during dextran administration, an osmotic diuretic is the recommended intervention. For patients with underlying renal disease, failure to clear dextran can lead to worsening of renal function.[10] Other relative contraindications include severe liver disease, preexisting edema, asthma, diabetes, epilepsy, and seizures. [8][10][11]
Can dextran cause rash?
Adverse effects of dextran are uncommon when appropriately administered. However, focal allergic reactions at the injection site or systemic anaphylactic or anaphylactoid reactions are possible: the presence of rash, hives, wheezing, chest tightness, and shortness of breath should cue the healthcare provider to this possibility. Immediate discontinuation and emergency treatment with intravenous fluids and H1/H2 blockers, epinephrine, and steroids may be warranted in severe cases for supportive treatment and to prevent airway closure.[9] Other potential adverse reactions include nausea, vomiting, arthralgias, fevers, and pain. Local injection site reactions can include venous thrombosis, infections at the injection site, and febrile reactions. It is prudent to monitor the injection site closely.
Does dextran cause liver problems?
Hepatic effects of dextran toxicity can include abnormal liver function test results with increased AST and ALT values, especially in patients undergoing surgery or cardiac catheterization procedures; this is because dextran accumulates in hepatocytes where it is metabolized, and excess levels of dextran can lead to hepatic oxidative stress. [11]
How to calculate iron dextran dose?
I find it much simpler to do the following dose calculation: simply multiply the deficit for the hemoglobin (in grams) by 250mg (amount needed to form a pint of blood), and add an additional 1000 mg to replace the normal reserve amount.
How much iron dextran should I take for anaphylaxis?
The obvious benefit for this “ test dose/rapid desensitization ” method is to allow the patient to begin with a miniscule dose of iron dextran, rather than the package insert recommended 25mg, dose, which is sufficient to precipitate full-blown anaphylaxis if the patient is indeed sensitive. The tiny dose gives an opportunity for the patient to have a smaller reaction and for the medical personnel to stop the infusion quickly, before the adverse reaction can fully develop. On occasion, I have needed to slow an infusion, but none of my patients was unable to complete the full infusion, and no “medical resuscitation” beyond diphenhydramine and prednisone or dexamethasone has ever been required.
How much iron dextran is in a drip chamber?
For an iron dextran dose of 3000 mg, the resulting concentration of iron dextran in the drip chamber would now be <0.008mg/cc, but as yet no iron dextran will have reached the patient.
How much saline is allowed into the drip chamber?
2. A large drip chamber (Buretrol brand) is connected to the IV bag and 100cc of saline is allowed into the drip chamber and the IV flow is begun, at 125 cc/hr.
What is the intravenous solution to be used?
The intravenous solution to be used is normal saline.
Is iron dextran off label?
The FDA has approved iron dextran for a maximal amount of 100 mg daily. Thus, TDI is an off-label use of iron dextran.
Can you take iron dextran intramuscularly?
Although iron dextran is approved for intramuscular administration, there have been reports in the medical literature of development of sarcoma or other malignancy in the vicinity of such injections, so I do not use intramuscular iron dextran.
How is iron dextran given?
Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.
What is iron dextran used for?
Iron dextran is used to treat iron deficiencies and iron deficiency anemia (low red blood cells). Iron dextran may also be used for purposes not listed in this medication guide.
What should I avoid while using iron dextran?
Follow your doctor's instructions about any restrictions on food, beverages, or activity.
What other drugs will affect iron dextran?
Other drugs may affect iron dextran, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.
When to prepare an injection?
Prepare an injection only when you are ready to give it. Do not use if the medicine has changed colors or has particles in it. Call your pharmacist for new medicine.
Where to get a first dose of a syringe?
You may receive your first dose in a hospital or clinic setting to quickly treat any serious side effects. Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you don't understand all instructions. Prepare an injection only when you are ready to give it.
Can you take iron dextran with a medical test?
This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using iron dextran. Each vial (bottle) is for one use only.
How should iron dextran be used?
Iron dextran injection comes as a solution (liquid) to inject into the muscles of the buttocks or intravenously (into a vein) by a doctor or nurse in a medical facility.
Why is iron dextran prescribed?
Why is this medication prescribed? Expand Section. Iron dextran injection is used to treat iron-deficiency anemia (a lower than normal number of red blood cells due to too little iron) in people who cannot be treated with iron supplements taken by mouth.
How long does it take for iron dextran to work?
You may experience a delayed reaction to iron dextran injection, beginning 24 to 48 hours after receiving a dose of medication and lasting for approximately 3 to 4 days. Tell your doctor if you experience any ...
What happens if you take iron dextran?
Iron dextran injection may cause severe or life-threatening reactions while you receive the medication. You will receive this medication in a medical facility and your doctor will watch you carefully during each dose of iron dextran injection. Tell your doctor if you experience any of the following symptoms during or after your injection: shortness of breath; difficulty swallowing or breathing; wheezing; hoarseness; swelling of the face, throat, tongue, lips, or eyes; hives; itching; rash; fainting; lightheadedness; dizziness; bluish discoloration of the skin, lips, fingers, or toes; cold, clammy skin; rapid, weak pulse; slow or irregular heartbeat; confusion; loss of consciousness; or seizures. If you experience a severe reaction, your doctor will slow or stop your infusion immediately and provide emergency medical treatment.
What to do if you miss an appointment for iron dextran?
If you miss an appointment to receive iron dextran injection, call your doctor as soon as possible.
What to keep on a prescription list?
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Can you get pregnant while taking iron dextran?
tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while receiving iron dextran injection, call your doctor.
Why is Dextran used in blood work?
Dextran is used to treat hypovolemia (decreased volume of circulating blood plasma), that can result from surgery, trauma or injury, severe burns, or other causes of bleeding.
What are the vital signs of dextran?
Your breathing, blood pressure, oxygen levels, kidney function , and other vital signs will be watched closely while you are receiving high-molecular weight dextran. Your blood will also need to be tested daily during treatment, and you may also need chest x-rays.
What is high-molecular weight dextran?
High-molecular weight dextran is a plasma volume expander made from natural sources of sugar (glucose). It works by restoring blood plasma lost through severe bleeding. Severe blood loss can decrease oxygen levels and can lead to organ failure, brain damage, coma, and possibly death. Plasma is needed to circulate red blood cells that deliver oxygen throughout the body.
What should I avoid after receiving high-molecular weight dextran?
Follow your doctor's instructions about any restrictions on food, beverages, or activity.
Does Dextran interact with other drugs?
This list is not complete. Other drugs may interact with high-molecular weight dex tran, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
Can you take dextran if you are allergic to it?
Before taking this medicine. You should not receive this medication if you are allergic to dextran, or if you have. severe kidney disease. severe congestive heart failure; or. uncontrolled bleeding. If possible before you receive dextran, tell your doctor if you have: liver or kidney disease;
Can you miss a dose of Dextran?
Because you will receive dextran in a clinical setting, you are not likely to miss a dose.
How is iron dextran ingested?
Iron dextran is ingested via endocytosis by the macrophages of the reticuloendothelial system. The fusion of the newly formed endosome with acidic lysosome results in the cleavage of the carbohydrate shell and the release of ferrous iron (Fe[2+]). Following release from its complex, Fe(2+) is shuttled across the endolysosomal membrane into the cytoplasm via divalent metal transporter 1 (DMT1), where it can be stored as a Fe-ferritin complex or get shuttled into the blood via ferroportin, a transmembrane protein. Once in the blood, Fe(2+) is immediately oxidized to ferric iron (Fe[3+]) by ceruloplasmin and subsequently bound by transferrin for transport to various sites throughout the body for utilization (i.e.,, to bone marrow for hemoglobin synthesis or to the liver for storage). [2][3] Hematologic responses of iron dextran may be observed within 3 to 10 days.
Does iron dextran cause hemosiderosis?
The administration of iron dextran over the total calculated required dose might result in acute iron toxicity, metabolic acidosis, and hemosiderosis. Treatment of iron toxicity requires the removal of excess iron via intravenous iron chelation therapy with deferoxamine.
Can you take iron dextran during pregnancy?
There is limited data regarding the safety of iron dextran during early pregnancy; therefore, Pavord et al. have suggested refraining from using intravenous iron dextran until the second or third trimesters.[8] Iron dextran may be found in trace amounts within breast milk; however, the World Health Organization (WHO) has indicated that iron dextran is compatible with breastfeeding.
Is iron dextran effective for chemotherapy?
Auerbach's multicenter randomized clinical trial demonstrated that iron dextran (INFeD) administration is useful in optimizing the effects of recombinant human erythropoietin in patients with chemotherapy-associated anemia .[4] The researchers found two different administration approaches to be effective; 1) a 25 mg test dose followed by a 75 mg bolus once weekly for the first three weeks and 100 mg over 5 minutes once weekly thereafter until achieving the total calculated required dose, and 2) a total dose infusion diluted in 500 mL of normal saline and infused at a rate of 175 mL per hour.
Is iron dextran a medicine?
Iron dextran is an injectable medication used in the management of iron deficiency anemia, particularly in patients who are unable to tolerate iron by mouth. It is in the class of medications referred to as iron replacement products. This activity outlines the indications, actions, and contraindications for iron dextran as a valuable agent in the treatment of iron deficiency anemia. Additionally, it will highlight the mechanism of action, adverse event profile, and other vital factors pertinent to members of the healthcare team.
Is iron dextran safe for anemia?
Additionally, iron dextran is contraindicated in any form of anemia, which is not the result of iron deficiency. Co-administration with dimercaprol should be avoided as iron-dimercaprol chelates are especially toxic to renal tissue. Patients taking angiotensin-converting enzyme inhibitors may be at an elevated risk of developing adverse reactions. Additionally, caution is necessary when administering iron dextran to patients with any disease states that mimic known major adverse effects; disease states of concern include atopy, asthma, rheumatoid arthritis, and cardiovascular disease.
What is the treatment for iron dextran?
Intravenous or intramuscular injections of iron dextran are indicated for treatment of patients with documented iron deficiency in whom oral administration is unsatisfactory or impossible.
How long does it take for iron dextran to clear?
Smaller doses (50-500mg) are cleared within 3 days, however, larger doses (>500mg) are cleared at a constant rate of 10-20mg/hr and are associated with increased plasma concentration of iron dextran for as long as 3 weeks. Iron replacement for blood loss: Dose (mg)= Blood loss (ml) x Hematocrit %.
Is iron dextran teratogenic?
Pregnancy Category C: Iron dextran has been shown to be teratogenic and embryocidal in mice, rats, rabbits, dogs, and monkeys when given in doses of about 3 times the maximum human dose. No consistent adverse fetal effects were observed in mice, rats, rabbits, dogs and monkeys at doses of 50 mg iron/kg or less.
Does iron cross the placenta?
It appears that some iron does reach the fetus, but the form in which it crosses the placenta is not clear. Nursing Mothers Caution should be exercised when INFeD is administered to a nursing woman. Traces of unmetabolized iron dextran are excreted in human milk. Pediatric Use.
Can INFED be mixed with other medications?
NOTE: Do not mix INFeD with other medications or add to parenteral nutrition solutions for intravenous infusion. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever the solution and container permit.
What is dextran solution?
Such a solution provides an osmotically neutral fluid that once in the body is digested by cells into glucose and free water. It is occasionally used to replace lost blood in emergency situations, when replacement blood is not available, but must be used with caution as it does not provide necessary electrolytes and can cause hyponatremia or other electrolyte disturbances.
What is dextran derived from?
Dextran is a complex branched glucan ( polysaccharide derived from the condensation of glucose ), originally derived from wine. IUPAC defines dextrans as "Branched poly-α-d-glucosides of microbial origin having glycosidic bonds predominantly C-1 → C-6". Dextran chains are of varying lengths (from 3 to 2000 kilodaltons ).
Why are dextran clots more easily lysed?
Clots formed after administration of dextrans are more easily lysed due to an altered thrombus structure (more evenly distributed platelets with coarser fibrin ). By inhibiting α-2 antiplasmin, dextran serves as a plasminogen activator, so possesses thrombolytic features.
How long does dextran stay in the blood?
The larger dextrans (>60,000 Da) are excreted poorly from the kidney, so remain in the blood for as long as weeks until they are metabolized. Consequently, they have prolonged antithrombotic and colloidal effects. In this family, dextran-40 (MW: 40,000 Da), has been the most popular member for anticoagulation therapy.
How are dextrans separated?
They are separated by fractional precipitation from protein-free extracts using ethanol. Some bacteria coproduce fructans, which can complicate isolation of the dextrans.
How long does it take for dextran-40 to be excreted?
Close to 70% of dextran-40 is excreted in urine within the first 24 hours after intravenous infusion, while the remaining 30% are retained for several more days.
Does dextran reduce vascular thrombosis?
These agents are used commonly by microsurgeons to decrease vascular thrombosis. The antithrombotic effect of dextran is mediated through its binding of erythrocytes, platelets, and vascular endothelium, increasing their electronegativity and thus reducing erythrocyte aggregation and platelet adhesiveness.
