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Iron dextran parenteral

Updated 2 Feb 2023 | Parenteral iron


Solution for injection containing iron (III) as iron (III)-hydroxide dextran complex.

Drugs List

  • COSMOFER 100mg/2ml injection
  • COSMOFER 500mg/10ml injection
  • iron dextran 100mg/2ml injection
  • iron dextran 500mg/10ml injection
  • Therapeutic Indications


    Rapid replenishment of depleted iron stores
    Treatment of iron deficiency anaemia


    The total cumulative dose of iron hydroxide dextran complex is determined by haemoglobin level and body weight. The dose and dosage schedule must be individually estimated for each patient based on a calculation of the total iron deficit.


    100mg to 200mg iron corresponding to 2ml to 4ml, two to three times a week depending on the haemoglobin level.

    Total dose infusion up to a total replacement dose corresponding to 20mg iron/kg body weight for rapid delivery of iron to the body iron stores.

    Refer to manufacturers information for details on calculation of dose using patient parameters.


    Children aged 14 to 18 years:
    (See Dosage; Adult)


    Iron hydroxide dextran complex solution may be administered by an intravenous infusion, by a slow intravenous injection or as an undiluted solution intramuscularly. Intravenous infusion is the preferred route of administration, as this may help to reduce the risk of hypotensive episodes.

    Iron dextran must be diluted only in 0.9% sodium chloride solution or in 5% glucose solution.

    Intravenous infusion
    Iron dextran may be administered in a dose of 100mg to 200mg iron (2ml to 4ml) diluted in 100ml 0.9% sodium chloride solution or in 5% glucose solution. The manufacturer advises to infuse the first 25mg of iron over a period of 15 minutes. If no adverse reactions occur during this time, the remaining portion of the infusion should be given at an infusion rate of not more than 100ml in 30 minutes.

    Intravenous injection
    Iron dextran may be administered in a dose of 100mg to 200mg iron (2ml to 4ml) by slow intravenous injection (0.2ml/min) diluted in 10ml to 20ml 0.9% sodium chloride or 5% glucose solution. The manufacturer advises that, on each occasion, the first 25mg should be injected slowly over a period of 1 to 2 minutes. If no adverse reactions occur within 15 minutes, the remaining portion of the injection may be given.

    Total dose infusion
    The total amount of iron hydroxide dextran complex, up to 20mg/kg bodyweight, is infused intravenously over 4 to 6 hours. The first 25mg of iron should be infused over a period of 15 minutes. If no reactions occur during this time, then the remaining portion of the infusion should be given. The rate of infusion may be increased progressively to 45 to 60 drops per minute. Patients should be observed during the infusion and for at least 30 minutes after completion. This method should be restricted to hospital use only.

    Injection into dialyser
    Iron hydroxide dextran complex may be administered during a haemodialysis session directly into the venous limb of the dialyser under the same procedure as outlined for intravenous administration.

    Deep Intramuscular injection
    The injections must be given by deep intramuscular injection into the muscle mass of the upper outer quadrant of the buttock only. For moderately active patients, the injections may be given daily into alternate buttocks. In inactive or bedridden patients the injections should be reduced to once or twice weekly.


    Children under 14 years
    Acute renal failure
    Decompensated liver disease
    First trimester of pregnancy
    Haemolytic anaemia

    Precautions and Warnings

    Allergic disposition
    Autoimmune disease
    Inflammatory disorder
    Second trimester of pregnancy
    Severe asthma
    Third trimester of pregnancy

    Exclude non-iron deficiency anaemia
    Have available adrenaline injection 1:1000 for anaphylaxis
    Treat and control infections prior to commencing therapy
    Do not start oral iron therapy until at least 5 days after last injection
    Observe patient closely during and immediately after administration
    Rapid intravenous administration may cause acute short-lasting hypotension
    Resuscitation facilities must be immediately available
    Diagnosis of iron deficiency must be based on appropriate laboratory tests
    Caution with every dose of IV iron even if previously well tolerated
    Monitor for hypersensitivity reactions for at least 30 mins after admin
    Large doses may impart brown colour to serum from blood sample after admin.
    May give falsely decreased values of serum calcium
    May give falsely elevated values of serum bilirubin
    Discontinue if anaphylactoid reaction occurs
    Do not take oral iron preparations during treatment
    Advise patients that hypersensitivity reactions may be life threatening

    Pregnancy and Lactation


    Iron dextran is contraindicated during the first trimester of pregnancy and should be used with caution during the second and third trimester of pregnancy.

    The manufacturer advises that iron deficiency anaemia occurring in the first trimester of pregnancy can normally be adequately treated with oral iron. It is recommended that treatment with intravenous iron should be confined to the second and third trimester if oral iron therapy is unsuitable.

    There is no adequate data from the use of iron hydroxide dextran complex during pregnancy. Studies in animals have shown teratogenicity and reproductive toxicity.

    Following administration of parental irons, foetal bradycardia may occur. This is usually due to a hypersensitivity reaction in the mother. As a result, if parental irons are intravenously administered to a pregnant woman, the unborn baby should be carefully monitored.


    Use iron hydroxide dextran complex with caution during breastfeeding.

    The manufacturer does not recommend breastfeeding whilst using iron hydroxide dextran complex.

    Limited data indicates that trace amounts of iron dextran are expressed into breast milk. The information on the clinical use of iron dextran during breastfeeding is not available. However, intravenous iron dextran has been used in preterm infants for anaemia of prematurity and would not be expected to cause any adverse effects in breastfed infants.

    Side Effects

    Abdominal pain
    Abscess formation (injection site)
    Anaphylactic reaction
    Anaphylactoid reaction
    Atrophy (localised)
    Blurred vision
    Cardiovascular collapse
    Chest pain
    Deafness (transient)
    Exacerbation of rheumatoid arthritis
    Feeling hot
    Foetal bradycardia
    Haemorrhage (injection site)
    Hypersensitivity reactions
    Inflammation (injection site)
    Influenza-like symptoms
    Kounis syndrome
    Local pain (injection site)
    Loss of consciousness (transient)
    Mental status changes
    Necrosis (injection site)
    Phlebitis (injection site)
    Stains skin brown


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: November 2021

    Reference Sources

    Summary of Product Characteristics: CosmoFer. Pharmacosmos UK Limited. Revised January 2020.

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Iron Dextran Last revised: 21 June 2021
    Last accessed: 08 November 2021

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    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

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