Parenteral Iron Therapy

Abstract

The clinical pharmacology of Fe-sorbitol citric acid complex for intramuscular injection was investigated in Fe deficient patients. Using material tagged with Fe-59, it disappeared from the injection site rapidly. After 24 hours, the mean residual at this location was 13.5%. The mean urinary excretion of the Fe was 20.4% in the first 24 hours. An average of 38.2% was used for hemoglobin synthesis in the first week. After an injection of 200 mg of Fe as the sorbitol citric acid complex, the serum Fe rose rapidly to a peak after 6 to 8 hours. The serum Fe-binding protein frequently is saturated at this point, but may not be. The serum Fe returns nearly to the original level in 24 hours. The clinical response of 56 Fe deficient patients to treatment with this preparation was studied. When Fe deficiency anemia was uncomplicated, hematologic response was rapid and complete. The presence of complications retarded the response to a variable degree. Twenty-five patients experienced side reactions, such as pain at the injection site (9), an unpleasant or metallic state (15), and acute iron intoxication manifested by nausea, vomiting, dizziness, malaise and generalized aches and pains (9). Reactions occurred after injections of 200 mg but were very uncommon after injections of 100 mg. One patient may have had an exacerbation of renal disease, but several others who also had prior renal damage suffered no ill effects from the medication. No ill effects on mother or child were noted among the small number of pregnant patients treated. The preparation is satisfactory for the treatment of Fe deficiency anemia when the parenteral route is needed, but individual doses should be limited to 100 mg because toxic reactions are much more common when larger doses are used.