Iron Therapy in Patients With Heart Failure and Iron Deficiency

Review of Iron Preparations for Practitioners

Marcin Drozd; Ewa A. Jankowska; Waldemar Banasiak; Piotr Ponikowski


Am J Cardiovasc Drugs. 2017;17(3):183-201. 

In This Article

Parenteral Iron Supplementation

Historically, in the general population with anaemia, the first parenteral iron preparations were administered as an iron oxyhydroxide complex,[88,89] which resulted in large amounts of non-transferrin-bound iron and therefore increased oxidative stress.[90] This resulted in several side effects, such as hypotension, nausea, vomiting, and peripheral oedema, to name a few.[91] This problem has been solved with the introduction of compounds containing iron in a core surrounded by a carbohydrate shell, which influences molecular size, pharmacokinetics and adverse reaction profiles.[92]

There are at least ten parenteral (IV or intramuscular) iron formulations approved for therapeutic use: ferric sorbitol, iron dextrans (high- and low-molecular weight dextran), iron polymaltose, iron sucrose (ISC), ferric gluconate, ferric carboxymaltose (FCM), iron isomaltoside 1000, and ferumoxytol ( Table 2 ). Five of them were formally investigated in patients with HF.[12,13,93–104] ISC was administered in seven studies (yielding a total of 136 patients),[94–100] and FCM was administered in two multicentre, randomized, placebo-controlled, double-blind trials (a total of 454 patients).[12,13] Iron dextran, iron isomaltoside 1000, and ferric gluconate were investigated only in a small single-centre study.

FCM, iron isomaltoside 1000, and ferumoxytol are considered more stable iron compounds, and are characterized by slower degradation. These formulations make it possible to administer high single doses of iron. Iron dextran can also be administered in a large single dose, but its safety profile in comparison to FCM, iron isomaltoside 1000, and ferumoxytol is worse as it can more often cause severe immunological reactions, including life-threatening anaphylaxis, and delayed hypersensitivity-like reactions.[105,106]