Ferric Carboxymaltose (IV Iron — Pregnancy)

How it works

It delivers a stable iron-carbohydrate complex directly into the circulation, allowing iron to be taken up by the reticuloendothelial system and used for haemoglobin synthesis and replenishment of iron stores.

Prescribing in practice

• Intravenous iron is generally avoided in the first trimester and should be given where facilities to manage hypersensitivity and anaphylaxis are available, with the patient observed during and after infusion.
• Ferric carboxymaltose can cause hypophosphataemia, which may be symptomatic or prolonged with repeated dosing, so consider checking phosphate when courses are repeated.
• Extravasation can cause persistent brown skin staining, so secure venous access and monitor the infusion site.

Monitoring

Monitor for hypersensitivity during and after the infusion and reassess haemoglobin and iron indices after an appropriate interval to confirm response.

Counselling the patient

• Report any rash, itching, swelling, breathlessness or feeling unwell during or shortly after the infusion.
• Tell staff immediately of any pain, stinging or swelling at the drip site as leakage can cause lasting skin staining.
• A blood test will be repeated later to check the anaemia has improved.

Evidence & guidelines

MHRA guidance highlights serious hypersensitivity and hypophosphataemia with intravenous iron, and NICE supports parenteral iron when oral iron is unsuitable in pregnancy.