Dextrafer

Dextrafer is an injection solution. It is an iron preparation that is used as an antianemic drug.

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Indications Dextrafer

It is indicated for iron deficiency in the body, in situations when a person needs to quickly replenish the levels of this substance. It is also used when treatment with oral iron medications is impossible or ineffective.

Release form

It is produced as an injection solution (5%), in 2 ml ampoules. One package contains 3, 5 or 10 ampoules.

Pharmacodynamics

Dextrafer helps to replenish the deficiency of iron ions in the body, observed in iron deficiency anemia of various origins, and also promotes erythropoiesis.

Iron is an important component of hemoglobin and myoglobin, as well as a number of enzymes. The main function of iron is the movement of oxygen molecules and electrons, and in addition, participation in oxidative metabolism processes.

Iron deficiency occurs due to failure to receive the required amount of this substance with food, disruption of the absorption process in the digestive tract, and also due to increased need (rapid growth) or loss of a large amount of blood.

As a result of a course of therapy with the drug, a gradual regression of laboratory and clinical (such as severe fatigue and weakness, as well as tachycardia, dizziness and dry skin) symptoms of anemia begins.

As a result of parenteral administration of iron-containing drugs, hemoglobin levels increase faster than as a result of oral administration of iron salts.

Pharmacokinetics

After intravenous administration of the drug, the iron-dextran complex accumulates fairly quickly inside the cells of the reticuloendothelial system, and also partially inside the spleen and liver. Iron is slowly excreted from these organs, after which it is synthesized with proteins.

Hematopoiesis increases over the next 6-8 weeks. The half-life is 5 hours (circulating iron) and 20 hours (total iron: both bound and circulating).

Iron synthesis with proteins occurs with subsequent formation of physiological components of iron - ferritin or hemosiderin, and also, to a small extent, transferrin. These elements are under physiological control, they increase hemoglobin levels, and at the same time replenish the level of iron in the body.

Iron is excreted quite slowly, and accumulation of this component can be toxic. Iron-dextran complex is not able to be eliminated by kidneys, as it has a large molecular weight. A small part of the element is excreted through the kidneys, as well as with feces.

After administration, the drug is absorbed from the injection site into the capillaries and into the lymphatic system. A significant amount of the substance is absorbed within 72 hours, and the remainder over the next 3-4 weeks.

Dextran is either metabolized or excreted.

Dosing and administration

The drug is prescribed to children aged 14 years and over, as well as to adults (administered intramuscularly and intravenously in the form of slow injections or drip infusion). Drip infusion intravenously is considered the most acceptable option, because with this method of administration the probability of developing hypotension is the lowest.

With any method of administration, before starting use, the patient must be given a test dose - this is 0.5 ml (adult dosage) or half the daily dosage (children's). If no adverse reaction occurs within the next hour, treatment is allowed to continue.

An anaphylactoid response to the drug usually occurs within a few minutes after the injection, but the patient's condition should be monitored throughout the entire period of administration. If any symptoms of intolerance appear after using Dextrafer, the drug should be discontinued immediately.

The course dosage of the drug is determined in accordance with the patient's weight, gender, and hemoglobin level. Doses are calculated based on general indicators of iron deficiency in the body.

As a rule, a dosage of 2-4 ml (approximately 100-200 mg of iron) per day is recommended in accordance with hemoglobin levels. If rapid restoration of iron levels is required, the drug is administered by infusion at a dosage of 0.4 ml/kg (or 20 mg of iron/kg).

If the total course dosage exceeds the maximum permissible daily dose, the drug administration should be divided into several procedures. If after 1-2 weeks of treatment the hematological parameters do not return to normal, the diagnosis should be reviewed.

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Use Dextrafer during pregnancy

It is prohibited to use the medicine in the 1st trimester. In the period of the II-III trimesters, it is prescribed only in cases where the possible benefit to the woman is more expected than the risk of adverse reactions in the fetus.

There is no data on whether the drug passes into breast milk, so it is recommended to stop breastfeeding while using the drug.

Contraindications

Among the contraindications of the drug:

• intolerance to the components of the drug;
• anemia that does not occur due to iron deficiency (hemolytic anemia is also one of these);
• excess iron in the body (with hemochromatosis or hemosiderosis);
• disorder of iron passage into hemoglobin (sideroachrestic form of anemia, as well as anemia caused by lead intoxication);
• presence of bronchial asthma;
• severe hemostatic disorders (such as hemophilia);
• the presence of eczema or other allergic skin diseases;
• hepatitis, as well as liver cirrhosis in the decompensated stage;
• presence of infectious pathologies;
• acute renal failure;
• rheumatoid arthritis in the presence of signs of an active inflammatory process.

There is insufficient information about the use of the drug in children under 14 years of age.

Side effects Dextrafer

The following side effects may occur as a result of using the medication (usually they are quite mild and pass quickly):

• cardiovascular disorders: occasionally arrhythmia or tachycardia develops, and in isolated cases an increase in heart rate may be observed;
• organs of the lymphatic and hematopoietic systems: occasionally, lymph nodes may enlarge or (in isolated cases) hemolysis may develop;
• neurological disorders: occasionally convulsions or tremors appear, loss of consciousness, dizziness and a feeling of anxiety may be observed. Paresthesia or headaches are observed sporadically;
• visual organs: blurred vision is observed sporadically;
• Hearing organs: occasional short-term deafness may occur;
• chest and respiratory organs: in rare cases, dyspnea develops, and in some cases, pain inside the sternum may appear;
• gastrointestinal disorders: occasionally nausea with vomiting, as well as abdominal pain, in very rare cases – diarrhea;
• subcutaneous tissue with skin: skin rashes and itching with redness, occasionally the development of Quincke's edema and increased sweating is observed;
• connective tissue and musculoskeletal organs: in rare cases, convulsions appear, and in isolated cases, myalgia develops;
• complications during the procedure: rarely - inflammation and pain at the injection site, abscesses, skin at the injection site turns brown, tissue necrosis develops. Phlebitis may occur as a result of intravenous administration;
• vascular disorders: occasionally the blood pressure level decreases, and in isolated cases it may, on the contrary, increase;
• general disorders: sometimes fever develops, and quite rarely fatigue may be felt;
• immune system: anaphylaxis is observed quite rarely, as well as anaphylactoid manifestations (rarely urticaria, dyspnea or fever develop, itching with a rash appears, as well as nausea, and in isolated cases respiratory arrest and cardiac arrest may occur);
• mental disorders: in rare cases, the patient's mental status may change.

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Overdose

An overdose of the drug may result in acute iron oversaturation – hemosiderosis. This disorder may be caused by an incorrect diagnosis – determining that the patient has iron deficiency anemia. As a result of repeated administration of large doses of iron, its excess may accumulate in the liver, causing inflammation, which may cause fibrosis.

To eliminate the disorder, treatment aimed at relieving the symptoms is necessary. If severe intoxication is observed, a specific antidote is used - deferoxamine (a chelate that synthesizes iron).

Interactions with other drugs

The drug has pharmaceutical incompatibility with other drugs, so it cannot be used in combination.

Like other parenteral iron medications, Dextrafer should not be used in combination with oral analogues, because this reduces the absorption of orally administered iron. The interval between parenteral use of the drug and the start of oral iron intake should be at least 5 days.

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Storage conditions

The ampoules with the medicine should be kept in the original packaging, in a place inaccessible to children. The temperature is a maximum of 25 ^o C. The ampoules must not be frozen.

Shelf life

Dextrafer is suitable for use for 2 years from the date of release of the drug.