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

Iron Formulations not Used in HF


A novel therapeutic option for HF patients is ferumoxytol (Feraheme®/Rienso®, AMAG Pharmaceuticals, Inc., Lexington, MA, USA/Takeda Pharmaceutical Company Limited, Tokyo, Japan). It is a non-stoichiometric magnetite (superparamagnetic iron oxide) coated with polyglucose sorbitol carboxymethyl ether.[121] The efficacy of this formulation in patients with CKD and IDA (irrespective of the dialysis dependence) appears to be non-inferior to ISC.[82] In addition, the safety profile of ferumoxytol is similar to placebo in anaemic patients with CKD.[122] Since only small amounts of free iron are present in the preparation, doses of 510 mg have been administered safely during an infusion of less than 30 s. In patients receiving a single dose of ferumoxytol equivalent to 316 mg of elemental iron, the mean serum terminal elimination half-life is 15 h.[123] In short-term studies,[82,122,124] IV ferumoxytol was safe and more effective than oral iron therapy in the correction of anaemia in anaemic patients with CKD.

Iron Polymaltose (Iron Dextrin)

This active substance is available in an oral, intramuscular, and IV form, and contains an iron(III)-hydroxide polymaltose complex with non-ionic iron. It has not been tested in HF patients. After an IV administration of 100 mg of iron polymaltose, the mean terminal half-life is 22 h. The maximal intramuscular dose for adults is 200 mg (this dose may be repeated every second day), and for IV, the maximal dose is up to 2500 mg in a slow infusion lasting over 5 h.[30] Initial test doses are not obligatory.[125] Although a parenteral formulation has been registered for more than 50 years, the evidence on the safety of this formulation is limited. Self-limiting side effects that occur up to 2 days after an IV infusion affect 26% of patients and include headache, fever, and arthralgia.[126]

Iron Sorbitol

Iron sorbitol is administered intramuscularly only (maximal daily dose of 100 mg), and has not been tested in HF patients.[127]