Infed Dosage

Generic name: iron dextran
Dosage form: injection, solution

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Oral iron should be discontinued prior to administration of INFeD.

Dosage:
I. Iron Deficiency Anemia: Periodic hematologic determination (hemoglobin and hematocrit) is a simple and accurate technique for monitoring hematological response, and should be used as a guide in therapy. It should be recognized that iron storage may lag behind the appearance of normal blood morphology. Serum iron, total iron binding capacity (TIBC) and percent saturation of transferrin are other important tests for detecting and monitoring the iron deficient state. After administration of iron dextran complex, evidence of a therapeutic response can be seen in a few days as an increase in the reticulocyte count. Although serum ferritin is usually a good guide to body iron stores, the correlation of body iron stores and serum ferritin may not be
valid in patients on chronic renal dialysis who are also receiving iron dextran complex. Although there are significant variations in body build and weight distribution among males and females, the accompanying table and formula represent a convenient means for estimating the total iron required. This total iron requirement reflects the amount of iron needed to restore hemoglobin concentration to normal or near normal levels plus an additional allowance to provide adequate replenishment of iron stores in most individuals with moderately or severely reduced levels of hemoglobin. It should be remembered that iron deficiency anemia will not appear until essentially all iron stores have been depleted. Therapy, thus, should aim at not only replenishment of hemoglobin iron but iron stores as well.
Factors contributing to the formula are shown below.

mg blood iron  =   mL blood   x    g hemoglobin  x  mg iron
lb body weight    lb body weight    mL blood          g hemoglobin

1. Blood volume . . . . . . . . . . . . . . . .65 mL/kg of body weight
2. Normal hemoglobin (males and females)
over 15 kg (33 lbs) . . . . . . . . . . . .14.8 g/dl
15 kg (33 lbs) or less . . . . . . . . . .12.0 g/dl
3. Iron content of hemoglobin . . . . . 0.34%
4. Hemoglobin deficit
5. Weight
Based on the above factors, individuals with normal hemoglobin levels will have approximately 33 mg of blood iron per kilogram of body weight (15 mg/lb).
Note: The table and accompanying formula are applicable for dosage determinations only in patients with iron deficiency anemia; they are not to be used for dosage determinations in patients requiring iron replacement for blood loss.
TOTAL INFeD REQUIREMENT FOR HEMOGLOBIN RESTORATION AND IRON STORES REPLACEMENT*

Patient Lean
Body Weight

Milliliter Requirement
of INFeD Based on
Observed Hemoglobin
 of







kg
lb
3
(g/dl)
4
(g/dl)
5
(g/dl)
6
(g/dl)
7
(g/dl)
8
(g/dl)
9
(g/dl)
10
(g/dl)
5
11
3
3
3
3
2
2
2
2
10
22
7
6
6
5
5
4
4
3
15
33
10
9
9
8
7
7
6
5
20
44
16
15
14
13
12
11
10
9
25
55
20
18
17
16
15
14
13
12
30
66
23
22
21
19
18
17
15
14
35
77
27
26
24
23
21
20
18
17
40
88
31
29
28
26
24
22
21
19
45
99
35
33
31
29
27
25
23
21
50
110
39
37
35
32
30
28
26
24
55
121
43
41
38
36
33
31
28
26
60
132
47
44
42
39
36
34
31
28
65
143
51
48
45
42
39
36
34
31
70
154
55
52
49
45
42
39
36
33
75
165
59
55
52
49
45
42
39
35
80
176
63
59
55
52
48
45
41
38
85
187
66
63
59
55
51
48
44
40
90
198
70
66
62
52
54
50
46
42
95
209
74
70
66
62
57
53
49
45
100
220
78
74
69
65
60
56
52
47
105
231
82
77
73
68
63
59
54
50
110
242
86
81
76
71
67
62
57
52
115
253
90
85
80
75
70
64
59
54
120
264
94
88
83
78
73
67
62
57
*Table values were calculated based on a normal adult hemoglobin of 14.8 g/dl for weights greater than 15 kg (33 lbs) and a hemoglobin of 12.0 g/dl for weights less than or equal to 15 kg (33 lbs).
The total amount of INFeD in mL required to treat the anemia and replenish iron stores may be approximated as follows:
Adults and Children over 15 kg (33 lbs): See Dosage Table. Alternatively the total dose may be calculated:
Dose (mL) = 0.0442 (Desired Hb - Observed Hb) x LBW + (0.26 x LBW)
Based on: Desired Hb = the target Hb in g/dl.
Observed Hb = the patient’s current hemoglobin in g/dl.
LBW = Lean body weight in kg. A patient’s lean body weight (or actual body weight if less than lean body weight) should be utilized when determining dosage.
For males: LBW = 50 kg + 2.3 kg for each inch of patient’s height over 5 feet
For females: LBW = 45.5 kg + 2.3 kg for each inch of patient’s height over 5 feet
To calculate a patient's weight in kg when lbs are known:


patient's weight in kilograms = weight in kilograms
                 2.2

Children 5 - 15 kg (11 - 33 lbs): See Dosage Table.
INFeD should not normally be given in the first four months of life. (See PRECAUTIONS: Pediatric Use.)
Alternatively the total dose may be calculated:
Dose (mL) = 0.0442 (Desired Hb - Observed Hb) x W + (0.26 x W)
Based on: Desired Hb = the target Hb in g/dl. (Normal Hb for Children 15 kg or less is 12 g/dl)
W = Weight in kg.
To calculate a patient's weight in kg when lbs are known:


patient's weight in kilograms = weight in kilograms
                 2.2

II. Iron Replacement for Blood Loss: Some individuals sustain blood losses on an intermittent or repetitive basis. Such blood losses may occur periodically in patients with hemorrhagic diatheses (familial telangiectasia; hemophilia; gastrointestinal bleeding) and on a repetitive basis from procedures such as renal hemodialysis. Iron therapy in these patients should be directed toward replacement of the equivalent amount of iron represented in the blood loss. The table and formula described under I. Iron Deficiency Anemia are not applicable for simple iron replacement values. Quantitative estimates of the individual’s periodic blood loss and hematocrit during the bleeding episode provide a convenient method for the calculation of the required iron dose. The formula shown below is based on the approximation that 1 mL of normocytic, normochromic red cells contains 1 mg of elemental iron:

Replacement iron (in mg) = Blood loss (in mL) x hematocrit
Example: Blood loss of 500 mL with 20% hematocrit
Replacement Iron = 500 x 0.20 = 100 mg
INFeD dose = 100 mg = 2 mL
                        50
Administration:
The total amount of INFeD required for the treatment of iron deficiency anemia or iron replacement for blood loss is determined from the table or appropriate formula. (See Dosage).
I. Intravenous Injection - PRIOR TO THE FIRST INTRAVENOUS INFeD THERAPEUTIC DOSE, ADMINISTER AN INTRAVENOUS TEST DOSE OF 0.5 ML. ADMINISTER THE TEST DOSE AT A GRADUAL RATE OVER AT LEAST 30 SECONDS. Although anaphylactic reactions known to occur following INFeD administration are usually evident within a few minutes, or sooner, it is recommended that a period of an hour or longer elapse before the remainder of the initial therapeutic dose is given. Individual doses of 2 mL or less may be given on a daily basis until the calculated total amount required has been reached. INFeD is given undiluted at a slow gradual rate not to exceed 50 mg (1 mL) per minute.
2. Intramuscular Injection - PRIOR TO THE FIRST INTRAMUSCULAR INFeD THERAPEUTIC DOSE, ADMINISTER AN INTRAMUSCULAR TEST DOSE OF 0.5 ML. (See BOXED WARNING and PRECAUTIONS.) The test dose should be administered in the buttock using the same technique as described in the last paragraph of this section. Although anaphylactic reactions known to occur following INFeD administration are usually evident within a few minutes or sooner, it is recommended that at least an hour or longer elapse before the remainder of the initial therapeutic dose is given. If no adverse reactions are observed, INFeD can be given according to the following schedule until the calculated total amount required has been reached. Each day’s dose should ordinarily not exceed 0.5 mL (25 mg of iron) for infants under 5 kg (11 lbs); 1.0 mL (50 mg of iron) for children under 10 kg (22 lbs); and 2.0 mL (100 mg of iron) for other patients. INFeD should be injected only into the muscle mass of the upper outer quadrant of the buttock - never into the arm or other exposed areas - and should be injected deeply, with a 2-inch or 3-inch 19 or 20 gauge needle. If the patient is standing, he/she should be bearing his/her weight on the leg opposite the injection site, or if in bed, he/she should be in the lateral position with injection site uppermost. To avoid injection or leakage into the subcutaneous tissue, a Z-track technique (displacement of the skin laterally prior to injection) is recommended.
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.
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