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Intravenous Iron Pregnancy: Avoid in first trimester; may be used in second/third trimester if benefit outweighs risk

Ferric Carboxymaltose

Brand names: Ferinject

Adult dose

Dose: Single dose: up to 1000 mg (maximum 20 mg/kg) over 15 minutes. Total replacement dose calculated by Ferinject table based on body weight and haemoglobin.
Route: IV infusion or slow IV injection
Frequency: Single dose; repeat after minimum 7 days if needed
Max: 1000 mg per dose (20 mg/kg if <14 kg body weight)
For iron deficiency anaemia where oral iron is ineffective or not tolerated. No test dose required. Faster administration than iron sucrose. Can cause transient hypophosphataemia.

Paediatric dose

Dose: 15 mg/kg
Route: IV infusion
Frequency: Single dose, repeat if needed after 7 days
Max: 750 mg per dose (children <14 kg); 1000 mg per dose (≥14 kg)
Concentration: 50 mg/mL mg/ml
Licensed ≥1 year of age for iron deficiency anaemia. Infuse at 100 mg/min; minimum infusion time per weight and dose chart.

Dose adjustments

Renal

Can be used in CKD/dialysis patients — monitor closely; preferred IV iron in CKD-anaemia

Hepatic

Avoid in decompensated hepatic disease

Paediatric weight-based calculator

Licensed ≥1 year of age for iron deficiency anaemia. Infuse at 100 mg/min; minimum infusion time per weight and dose chart.

Clinical pearls

  • Ferinject does NOT require a test dose (unlike iron dextran) — reduces preparation time
  • Transient hypophosphataemia: check phosphate 2–4 weeks post-infusion; clinically relevant hypophosphataemia reported especially with repeat doses
  • Preferred IV iron in CKD — Ferinject and iron sucrose both widely used
  • FAIR-HF trial: IV iron improves 6-minute walk and quality of life in HFrEF with iron deficiency (ferritin <100 or 100–299 with TSAT <20%)

Contraindications

  • Anaemia not caused by iron deficiency
  • Iron overload (haemochromatosis)
  • Hypersensitivity to iron carboxymaltose
  • 1st trimester of pregnancy

Side effects

  • Hypophosphataemia (significant — check phosphate after treatment)
  • Nausea
  • Headache
  • Dizziness
  • Flushing
  • Hypertension
  • Anaphylactoid reactions (rare)
  • Injection site discolouration

Interactions

  • Oral iron — do not give simultaneously; absorption interference and increased side effects
  • ACEi — increased risk of hypersensitivity reactions

Monitoring

  • Haemoglobin and ferritin/TSAT (at 4–8 weeks)
  • Phosphate (2–4 weeks post-infusion)
  • Blood pressure during infusion
  • Anaphylaxis monitoring during and 30 min after infusion

Reference: BNFc; BNF; FAIR-HF Trial (Anker et al, NEJM 2009); NICE NG203; Ferinject SPC. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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