IV Iron Preparation — Iron Deficiency Anaemia in Pregnancy Pregnancy: Post 13 weeks — avoid first trimester

Ferric Carboxymaltose (IV Iron — Pregnancy)

Brand names: Ferinject

Adult dose

Dose: Single dose up to 1000 mg IV. Dose based on haemoglobin and body weight (Ferinject dosing table). Standard: 1000 mg IV in 100 mL NaCl 0.9% over 15 min (if weight ≥66 kg and Hb <10 g/dL)

Route: IV infusion

Frequency: Single dose (repeat based on response and Hb)

Max: 1000 mg per single infusion; 1500 mg/week

NICE: IV iron recommended in pregnancy if Hb <100 g/L after 13 weeks, or if oral iron intolerance/malabsorption/non-response. Ferinject does not require a test dose. Administer only in settings with resuscitation facilities. Not licensed in first trimester (data limited).

Paediatric dose

Route: N/A

Frequency: N/A

Max: N/A

Not applicable in obstetric indication; paediatric IV iron — see separate entry

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Clinical pearls

IV iron corrects iron deficiency anaemia faster than oral iron — beneficial in late pregnancy when there is insufficient time for oral response
Ferinject can be given as a single large dose (up to 1000 mg in 15 min) — much more convenient than older IV iron preparations (iron sucrose required multiple infusions)
Hypophosphataemia: Ferinject causes transient but sometimes severe hypophosphataemia — check phosphate at 4–6 weeks post-infusion in high-risk patients
No test dose required for Ferinject (unlike older iron dextran preparations)
Target Hb: >105 g/L at booking; >110 g/L at 28 weeks (WHO thresholds for iron supplementation in pregnancy)

Contraindications

First trimester of pregnancy
Iron overload
Hypersensitivity to IV iron
Anaemia not caused by iron deficiency

Side effects

Hypersensitivity/anaphylaxis (rare — resuscitation facilities required)
Transient hypophosphataemia (common with Ferinject — check phosphate after large doses)
Nausea
Injection site reactions
Headache
Hypertension (transient)

Interactions

Oral iron — do not take simultaneously (IV iron suppresses absorption of oral iron for up to 5 days)

Monitoring

Haemoglobin and ferritin (4–6 weeks post-infusion)
Serum phosphate (4–6 weeks, especially in recurrent/large doses)
Vitals during infusion (anaphylaxis monitoring for 30 min post-dose)

Reference: BNFc; NICE NG25; RCOG Iron Deficiency Anaemia in Pregnancy (2015); BNF; Ferinject SPC. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways