Intravenous (IV) iron products (use in adults)

Drug	Trade (brand) name	Concentration of elemental iron	Dosing (adults)	Test dose	Premedication
Ferric carboxymaltose (FCM)^*	Injectafer (United States), Ferinject (United Kingdom and other countries)	50 mg/mL	Weight ≥50 kg: 1 or 2 doses of 750 mg, given 7 or more days apart or Weight <50 kg: 1 or 2 doses of 15 mg/kg, given 7 or more days apart	Not required	We do not routinely premedicate for any of the IV iron products. For patients with asthma or multiple drug allergies, we often give methylprednisolone and a histamine 2 (H2) receptor blocker prior to the iron infusion. For patients with inflammatory arthritis, we often give methylprednisolone followed by a brief course of oral prednisone. We do not give diphenhydramine as a premedication.
Ferric derisomaltose (previously called iron isomaltoside)	Monoferric (United States, Canada), Monofer (United Kingdom, other countries)	100 mg/mL	Weight ≥50 kg: Single dose of 1000 mg or Weight ≥50 kg: Up to 3 doses of 500 mg given over 7 days or Weight <50 kg: Single dose of 20 mg/kg	Not required
Ferric gluconate (FG)^¶	Ferrlecit	12.5 mg/mL	Multiple doses of 125 to 250 mg	Not required, but recommended if the patient has a history of multiple drug allergies
Ferumoxytol^Δ	Feraheme (United States), Rienso (United Kingdom and other countries)	30 mg/mL	Single dose of 1020 mg or 2 doses of 510 mg, given 3 to 8 days apart	Not required
Iron dextran, low molecular weight (LMW ID)^◊	INFeD (United States), Dexiron (Canada), CosmoFer (United Kingdom and other countries)	50 mg/mL	Single dose of 1000 mg (diluted in 250 mL normal saline) given over 1 hour or Multiple doses of 100 mg	Yes, 25 mg (0.5 mL) prior to the first dose
Iron sucrose (IS)^¶	Venofer	20 mg/mL	Multiple doses of 100 to 300 mg	Not required, but recommended if the patient has a history of multiple drug allergies

IV iron is not used during the first trimester of pregnancy due to lack of safety data. Dosing information in this table is for adults and includes some dosing recommendations not listed in the approved product information. For all products, slow initial infusion is prudent; the patient is observed closely for infusion reactions. Refer to UpToDate for the management of iron deficiency and refer to the most recent product labeling for additional information. Product labeling for all of the products available in the United States is available on the US Food and Drug Administration website (https://www.accessdata.fda.gov/scripts/cder/drugsatfda/) or the National Library of Medicine (https://dailymed.nlm.nih.gov/dailymed/).

* Ferric carboxymaltose can cause hypophosphatemia and should be avoided in individuals with hypophophatemia or at increased risk. Monitoring of serum phosphate is needed in individuals receiving more than 1 dose.

¶ FG and iron sucrose require multiple infusions, which increase the risk of complications and infusion reactions. We avoid these formulations in non-dialysis patients unless there are no other options, especially during pregnancy and breastfeeding. FG contains benzyl alcohol as a preservative, and we avoid this during pregnancy and nursing due to potential risk to the fetus/neonate.

Δ Notify the radiologist if patient has a magnetic resonance imaging (MRI) scan, including noncontrast scanning, within 3 months of ferumoxytol administration, as the properties of ferumoxytol affect the appearance of different imaging sequences.

◊ High molecular weight iron dextran (HMW ID) is no longer available.

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Intravenous (IV) iron products (use in adults)