The article will provide an overview of iron preparations for intravenous administration.
Anemia is one of the most serious problems of modern medicine. According to WHO experts, about 1.7 billion people worldwide, or 25% of the population, suffer from this pathology. The incidence of anemia was very high in all groups and amounted to 28-47% in children, 44% in pregnant women, 31% in non-pregnant women, 24% in older people and 15% in men.
In half the cases, the main cause of this pathological condition is iron deficiency, which can occur due to chronic blood loss (menstruation), insufficient content of the element in food, alcoholism, in childhood and adolescence, during pregnancy and the postpartum period.
What is the deficit?
Deficiency of this element is absolute and functional. The latter develops in the case when its adequate content in the body is insufficient, but against the background of an increase in the bone marrow demand for it during erythropoiesis stimulation.
A special role in the metabolism is played by hepsidin, which is a hormone that is produced in the liver. It comes in contact with ferroportin (a protein that carries iron transport) and inhibits the absorption of this element in the intestine. An increase in hepcidin, which is noted in inflammatory processes, is considered the main cause of the development of anemia. In addition, the concentration of hepcidin rises in chronic kidney diseases and affects the development of nephrogenic anemia, as well as susceptibility to stimulants of erythropoiesis. Under the action of erythroepoetin, with increased erythropoiesis, the rate of mobilization of iron becomes insufficient to meet the increased need for bone marrow. Proliferating erythroblasts require an increasing amount of the element, which causes depletion of the labile iron pool and a decrease in the level of ferritin. It takes a certain amount of time to dissolve and mobilize it from hemosiderin. As a result, the amount of the element entering the bone marrow decreases, which contributes to the development of its deficiency.
Deficit elimination
Regardless of the main causes of iron deficiency anemia, the main way to treat it is to eliminate the deficiency. For these purposes, iron preparations for intravenous administration are most often used. Despite the fact that medications for oral administration are more convenient, they have a slower effect, can be ineffective in case of impaired absorption and often provoke undesirable reactions from the digestive system (in 10-40% of patients). Accordingly, the use of iron preparations for intravenous administration in case of anemia is advisable in those cases where it is necessary to quickly achieve the desired effect (for example, with a severe degree of pathology, especially in people suffering from heart diseases or undergoing chemotherapy), as well as with poor tolerance of medications for oral use or their inefficiency (chronic iron loss, malabsorption syndrome). In addition, intravenous methods of introducing iron are considered the methods of choice in the treatment of medications that stimulate erythropoiesis in patients with chronic kidney diseases, inflammatory bowel pathologies, and malignant tumors.
Some drugs based on this element can be used intramuscularly, however, such injections are very painful and cause a discoloration of the skin.
So, which iron supplements are most effective for intravenous administration?
FERINJECT
The medicine “Ferinzhekt” - a drug that quickly compensates for the deficiency of this element, rarely causes hypersensitivity reactions characteristic of medications that contain dextran. This tool provides a gradual release of iron, which reduces the likelihood of toxic effects.
The dosage form of the iron preparation for intravenous administration of “Ferinzhekt” is a solution, which is an opaque liquid of a dark brown color. The solutions are poured into transparent glass bottles, which are packed in cardboard boxes. The medicine contains the active element - iron carboxymaltose - and auxiliary components: sodium hydroxide, hydrochloric acid, water for injection.
Active component
The active component of the iron preparation for intravenous administration in case of anemia “Ferinzhekt” is ferric iron. A medicine is a complex consisting of a carbohydrate ligand and a multinuclear iron-hydroxide core. Due to the stability of the complex, only a small amount of bound iron is released, also called free or labile. The purpose of creating such a complex is to provide a source of a utilized element for proteins transporting iron and depositing it.
According to the results of medical studies, it was determined that the hematological response and filling of the iron depot occurs faster as a result of intravenous administration of the solution than with the oral administration of analog medications.
Ferinject, an intravenous iron preparation, is used to treat iron deficiency anemia, when the use of oral iron medications may be ineffective or for some reason impossible. Prior to the use of the drug, parenteral confirmation of anemia by laboratory tests is necessary.
Contraindications
Contraindications to the appointment of this medication are: non-deficient anemia, violation of the disposal of the element, its excess, age up to 14 years, high sensitivity. With caution, the medication is used for liver failure, bronchial asthma, infectious diseases (risk of suppression of erythropoiesis), eczema, atopic dermatitis. To avoid an excess of iron, careful monitoring of its concentration in the blood is necessary.
What other iron preparation for intravenous administration is prescribed by doctors?
Cosmofer
This medicine is an iron preparation for parenteral use. Mechanism of action: after intravenous injection, the main element - hydroxide of the dextran complex - is captured by the cells of RES, mainly the liver and spleen, where the substance is slowly released and its binding to proteins takes place. After intravenous administration of the Cosmofer iron preparation for 6–9 weeks, increased hematopoiesis is observed. The circulating iron in the plasma is excreted by the cells of the reticuloendothelial system, which divides the complex into its components - dextran and iron, which quickly binds to proteins and forms hemosiderin - the physiological form of this substance, as well as transferrin. This is iron that undergoes physiological control, replenishes hemoglobin and depleted reserves of this element in the body.
Iron is necessary for the proper functioning of non-heminic and heminic substrates: myoglobin, hemoglobin, cytochromes, catalases and peroxidases, which are involved in oxygen transfer, removal of peroxides and tissue respiration. An adequate amount of iron is necessary for normal erythropoiesis - the entry of hemoglobin into erythroblasts. Iron is transported to mature red blood cells by release from transferritin on the precursor membrane. Dosage determination is based on the concentration of the target hemoglobin and iron depot, which are used according to the weight of the patient.
Typically, the drug is administered in a dosage of 100 mg. An iron preparation for intravenous administration of this brand should be used 2-3 times a week. The interval of drug administration is determined depending on the concentration of hemoglobin in the blood. The half-life of circulating iron in the blood is 6 hours, for a total of 18 hours.
An excess of iron can lead to a violation of its excretion (hemosiderosis, hemochromatosis). A small amount of the element is excreted in urine and feces. After intramuscular injection, iron-dextran is absorbed at the injection site and enters the small vessels and lymphatic system. The main part of the injected substance is absorbed after 72 hours, the rest within the next 3-4 weeks. Dextran undergoes a process of metabolism or excretion. The recommended dosage is intramuscularly - 1 time per week, with intravenous administration, the iron preparation is used 2-3 times a week, as mentioned earlier. With the rapid introduction of a medicinal product, an attack of hypotension may occur.
Indications
Indications for the prescription of this medication are:
- the need for rapid transfer of iron to the depot;
- renal anemia;
- hemo- and peritonial dialysis;
- alternative to blood transfusions;
- inability to absorb into the digestive tract;
- intolerance to iron for internal use;
- pregnant anemia.
"Cosmofer" contraindications
The list of contraindications for the use of this medication includes:
- first trimester of pregnancy;
- anemia not triggered by iron deficiency;
- age up to 14 years;
- oversaturation of the body with iron or a violation of its excretion;
- bronchial asthma, eczema or other types of atopic allergies;
- hypersensitivity to the drug;
- hepatitis and cirrhosis in the stage of decompensation;
- acute or chronic infections;
- rheumatoid arthritis with signs of inflammation;
- renal failure.
Consider other means to increase hemoglobin in the blood. What is this Ferum Jet intravenous iron preparation?
Ferrum Lek
This pharmacological agent is often incorrectly called the "Ferum Jet."
It is made on the basis of hydroxide-polymaltose complexes of ferric iron. This active element has a high molecular weight and is not able to be absorbed by a concentration gradient or by diffusion. The structure of the hydroxide-polymaltose complex is similar to ferritin - a natural complex that consists of a protein part and iron. These differences from the divalent analogues of this drug are considered its advantages - the drug is actively absorbed through the mucous membranes, and the absorption of its excess is impossible - exactly the amount of substance that is needed is ingested. The drug does not have a damaging effect on the mucous membranes and membranes, since it is deprived of the oxidizing ability of ferrous iron.
In the body, iron is necessary for the formation of hemoglobin in the cells of the bone marrow, tissue enzymes and muscle protein. Hemoglobin carries oxygen to the tissues, and carbon dioxide is taken from them. The medicine "Ferrum Lek" quickly penetrates the blood when taken orally, absorbed in the duodenum. After that, it binds to the transferrin protein and spreads throughout the tissues. This medication is stable and does not release iron ions. The medicine is removed from the body through the intestines.
“Ferrum Lek” is produced in the form of chewable tablets, solutions for injection and syrups for oral administration. Indications for its appointment is the treatment of iron deficiency conditions, which are associated with excessive consumption or insufficient iron content in the body. In addition to iron deficiency, the drug stops its latent deficiency, when there is no manifestation of anemia, but with the help of laboratory tests, a decrease in iron content is detected.
The list of contraindications for the use of the “Ferrum Lek” medication includes: excessive iron content (hemochromatosis), hypersensitivity to the medication.
What other names of iron preparations for intravenous administration are most popular?
The drug "Venofer"
This drug is an antianemic drug for parenteral administration. Release form - injection solution, ampoules of 5 ml. In a cardboard package 5 ampoules and instructions.
The main active ingredient is iron III sucrose complex.
As auxiliary components, the drug contains sodium hydroxide, water for injection.
Indications for the use of an iron preparation for intravenous administration are conditions accompanied by a deficiency of iron in the body. The drug should be used:
- when you need to quickly restore the concentration of iron;
- if there is intolerance to oral agents or the prescribed treatment regimen has not been observed;
- with intestinal diseases, when there is intolerance to oral drugs.
Contraindications "Venofer" are:
- violations of the process of disposal of the element;
- symptoms of its excess (hemochromatosis, hemosiderosis);
- individual intolerance to the components of the drug;
- I trimester of pregnancy.
The dosage for adults and elderly patients is usually 100-200 mg once to three times a week.
Side effects with intravenous iron supplements
These funds very often cause negative reactions from the body. Sometimes taking iron supplements leads to:
- Disorders of the stomach and intestines - vomiting, nausea, heartburn, lack of appetite, pain, belching, and diarrhea.
- Constipation and discoloration of feces.
- Intoxication of the body. Iron ions in large quantities provoke the growth of pathogenic microflora.
Reviews
There are a lot of medicines containing iron in the modern pharmacological market, and there are quite a lot of positive reviews about each of them. Particularly popular are medicines such as Ferrum Lek and Ferinject. Patients noted that during treatment they quickly increased hemoglobin, which was confirmed not only by laboratory parameters, but also by general health. The Cosmofer medicine is also in demand, however, patients during its administration often observe the occurrence of some adverse reactions, in particular digestive disorders. Nevertheless, this does not mean that the drug is ineffective. Experts recommend these medications, however, indicate that they should be taken in the right dosages and observing the dosage regimen.
We conducted a review of means - iron preparations for intravenous administration.