(fer ue MOX i tol)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous [preservative free]:
Feraheme: 510 mg/17 mL (17 mL)
Brand Names: U.S.
- Iron Salt
Superparamagnetic iron oxide coated with a low molecular weight semisynthetic carbohydrate; iron-carbohydrate complex enters the reticuloendothelial system macrophages of the liver, spleen, and bone marrow where the iron is released from the complex. The released iron is either transported into storage pools or is transported via plasma transferrin for incorporation into hemoglobin.
Vd: 3.16 L
Iron released from iron-carbohydrate complex after uptake in the reticuloendothelial system macrophages of the liver, spleen, and bone marrow
~15 hours; ferumoxytol is not removed by hemodialysis
Use: Labeled Indications
Iron-deficiency anemia: Treatment of iron-deficiency anemia in adults with an intolerance or unsatisfactory response to oral iron or who have chronic kidney disease
Hypersensitivity to ferumoxytol, other IV iron products, or any component of the formulation
Doses expressed in mg of elemental iron. Note: Test dose: Product labeling does not indicate need for a test dose.
Iron-deficiency anemia: IV: 510 mg as an IV infusion, followed by a second 510 mg IV infusion 3 to 8 days after initial dose. Assess response at least 30 days following the second dose. The recommended dose may be readministered in patients with persistent or recurrent iron-deficiency anemia.
Refer to adult dosing.
Dosing: Renal Impairment
No dosage adjustment necessary.
Hemodialysis: Not removed by hemodialysis; however, administer dose after at least 1 hour of hemodialysis has been completed and once blood pressure has stabilized.
Dosing: Hepatic Impairment
There are no dosage adjustments provided in the manufacturer's labeling.
Must be diluted prior to administration. To prepare for intravenous infusion, dilute in 50 to 200 mL of NS or D5W.
IV: Administer diluted as a slow IV infusion over at least 15 minutes. Patient should be in a reclined or semi-reclined position during the infusion; monitor for signs of hypersensitivity (including blood pressure and pulse) for at least 30 minutes after infusion. Note: Serious hypersensitivity reactions have been observed with rapid IV injection (<1 minute) (Macdougall 2014; Vadhan-Raj 2014). Wait ≥30 minutes between administration of ferumoxytol and other agents that may cause serious hypersensitivity reactions and/or hypotension (eg, chemotherapy, monoclonal antibodies).
Hemodialysis patients: Administer dose after at least 1 hour of hemodialysis has been completed and once blood pressure has stabilized.
Store intact vials at 20°C to 25°C (68°F to 77°F); excursions are permitted between 15°C and 30°C (59°F and 86°F). Solutions diluted in NS or D5W at concentrations of 2 to 8 mg/mL elemental iron should be used immediately, but may be stored at 23°C to 27°C (73°F to 81°F) for up to 4 hours or refrigerated at 2°C to 8°C (36°F to 46°F) for up to 48 hours. Discard unused portion.
Bictegravir: Iron Salts may decrease the serum concentration of Bictegravir. Management: Bictegravir, emtricitabine, and tenofovir alafenamide can be administered with iron salts under fed conditions, but coadministration with or 2 hours after an iron salt is not recommended under fasting conditions. Consider therapy modification
Dimercaprol: May enhance the nephrotoxic effect of Iron Salts. Avoid combination
May interfere with MR imaging; alterations may persist for ≤3 months following use, with peak alterations anticipated in the first 2 days following administration. If MR imaging is required within 3 months after administration, use T1- or proton density-weighted MR pulse sequences to decrease effect on imaging. Do not use T2-weighted sequence MR imaging prior to 4 weeks following administration.
Serum iron and transferrin-bound iron may be overestimated in laboratory assays if level is drawn during the first 24 hours following administration (due to contribution of iron in ferumoxytol).
1% to 10%:
Cardiovascular: Hypotension (≤3%), edema (2%), peripheral edema (2%), chest pain (1%), hypertension (1%)
Central nervous system: Dizziness (2% to 3%), headache (2% to 3%), fatigue (2%)
Dermatologic: Pruritus (1%), skin rash (1%)
Gastrointestinal: Diarrhea (1% to 4%), nausea (2% to 3%), constipation (2%), vomiting (2%), abdominal pain (1%)
Hypersensitivity: Hypersensitivity reaction (≤4%; serious hypersensitivity: <1%)
Neuromuscular & skeletal: Back pain (1%), muscle spasm (1%)
Respiratory: Cough (1%), dyspnea (1%)
Miscellaneous: Fever (1%)
<1%, postmarketing, and/or case reports: Anaphylaxis, angioedema, cardiac arrhythmia, cardiac failure, cyanosis, ischemic heart disease, loss of consciousness, syncope, tachycardia, unresponsive to stimuli, urticaria, wheezing
Concerns related to adverse effects:
• Hypersensitivity reactions: [US Boxed Warning]: Serious hypersensitivity reactions, (some fatal), including anaphylaxis may occur, presenting with cardiac/cardiorespiratory arrest, clinically significant hypotension, syncope, or unresponsiveness even in patients who previously tolerated ferumoxytol. Infuse over ≥15 minutes and have equipment for resuscitation and trained personnel experienced in handling emergencies immediately available during use. Monitor patients for signs/symptoms of hypersensitivity reactions, including blood pressure and pulse during and ≥30 minutes (until clinically stable) following administration. Other hypersensitivity reactions have also occurred (pruritus, rash, urticaria, wheezing). Patients with multiple drug allergies may have greater risk of anaphylaxis; elderly patients with multiple or serious comorbidities who develop hypersensitivity and/or hypotension after ferumoxytol may be at greater risk for serious adverse events.
• Hypotension: Hypotension, including serious hypotensive reactions, may occur; monitor patients for hypotension following administration.
Concurrent drug therapy issues:
• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
• Appropriate use: Do not administer in the presence of tissue iron overload; periodic monitoring of hemoglobin, serum ferritin, serum iron, and transferrin saturation is recommended. Serum iron and transferrin-bound iron may be overestimated in laboratory assays if level is drawn during the first 24 hours following administration.
• Magnetic resonance (MR) imaging: Administration may alter MR imaging; conduct anticipated MRI studies prior to use. MR imaging alterations may persist for ≤3 months following use, with peak alterations anticipated in the first 2 days following administration. If MR imaging is required within 3 months after administration, use T1- or proton density-weighted MR pulse sequences to decrease effect on imaging. Do not use T2-weighted sequence MR imaging prior to 4 weeks following ferumoxytol administration. Ferumoxytol does not interfere with X-ray, computed tomography (CT), positron emission tomography (PET), single photon emission computed tomography (SPECT), ultrasound or nuclear medicine imaging.
Hemoglobin, serum ferritin, serum iron, transferrin saturation (at least 1 month following second injection and periodically); signs/symptoms of hypersensitivity reactions, blood pressure, pulse (during and ≥30 minutes following administration)
Untreated iron deficiency anemia is associated with adverse pregnancy outcomes including low birth weight, preterm delivery, and maternal postpartum anemia. Other agents may be preferred for use of iron deficiency anemia during pregnancy (Breymann 2017).
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience diarrhea, headache, nausea, or constipation. Have patient report immediately to prescriber signs of infusion reaction (blue/gray skin or nail discoloration; chest, jaw, or left arm pain; rash; angioedema; dizziness or passing out; difficulty breathing; wheezing), dizziness, passing out, or swelling of arms or legs (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
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- Drug class: iron products
Other brands: Feraheme