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Which IV iron products require administration of a test dose before the infusion?

Many IV iron replacement products are currently available, including iron dextran (Dexferrum, Infed), iron sucrose (Venofer), ferric gluconate (Ferrlecit), and ferumoxytol (Faraheme). The oldest of these products, iron dextran, has been associated with an elevated risk of anaphylactic-type reactions during infusion. A boxed warning on iron dextran products states that test doses should be used prior to administering the full infusion.

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Test doses are not mandated for other iron products. Some patient characteristics may increase the risk of an anaphylactic-type reaction, including a history of reactions to other iron products, current use of an ACE inhibitor (eg, lisinopril [Zestril, Prinivil, generics], ramipril [Altace, generics], etc), or multiple drug allergies. Patients with these risk factors should receive test doses prior to use of any IV iron product. Note that some patients who tolerate the test dose may still develop an anaphylactic-type reaction. Parenteral iron products should be administered in a facility with adequate staff and resources to manage these potentially fatal reactions. ONA

Lisa Thompson is assistant professor, Department of Clinical Pharmacy, University of Colorado Denver School of Pharmacy, Aurora, Colorado.