Ferumoxytol: Comprehensive Guide to Iron Replacement Therapy

Summary of Key Points

Ferumoxytol is a prescription medication used to treat iron deficiency anemia (IDA) in adults, particularly those with chronic kidney disease (CKD). It is an intravenous (IV) iron replacement therapy designed to increase iron levels in the body. Ferumoxytol is typically prescribed when oral iron supplements are either ineffective or poorly tolerated. Always consult your healthcare provider before starting or adjusting this medication.

Names of Medication

US Brand Name: Feraheme

Generic Name: Ferumoxytol

The generic name refers to the active ingredient, while the brand name is assigned by the manufacturer. In this article, the generic name will be listed in parentheses.

Pharmacologic Category

Iron Replacement Products

Parenteral Iron Preparations

Ferumoxytol Dosing Guidelines

Ferumoxytol is indicated for treating iron deficiency anemia (IDA) in adults with various underlying conditions. Always follow your healthcare provider’s instructions and consult them before making any changes to your dose. You can also schedule a telemedicine appointment with one of our providers to discuss your treatment options.

Iron Deficiency Anemia (IDA) in Chronic Kidney Disease (CKD)

Initial dose: 510 mg IV injection

Second dose: 510 mg IV injection, administered 3 to 8 days after the first dose

Frequency: Typically, two doses are sufficient, but your doctor may recommend additional doses based on your iron levels.

Iron Deficiency Anemia in Heart Failure

Initial dose: 510 mg IV injection

Second dose: 510 mg IV injection, administered 3 to 8 days after the first dose

Frequency: Follow-up doses may be required depending on your iron levels and response to treatment.

Iron Deficiency Anemia in Inflammatory Bowel Disease (IBD)

Initial dose: 510 mg IV injection

Second dose: 510 mg IV injection, administered 3 to 8 days after the first dose

Frequency: Your healthcare provider will monitor your iron levels and may adjust treatment as needed.

Iron Deficiency Anemia in Cancer

Initial dose: 510 mg IV injection

Second dose: 510 mg IV injection, administered 3 to 8 days after the first dose

Frequency: Additional doses may be required based on your iron levels and overall health.

Pregnancy-Related Anemia

Initial dose: 510 mg IV injection

Second dose: 510 mg IV injection, administered 3 to 8 days after the first dose

Frequency: Treatment duration will depend on your iron levels and response to therapy.

Dialysis-Related Anemia

Initial dose: 510 mg IV injection

Second dose: 510 mg IV injection, administered 3 to 8 days after the first dose

Frequency: Your healthcare provider will monitor your iron levels and may recommend additional doses.

Iron Deficiency Anemia Due to Malnutrition

Initial dose: 510 mg IV injection

Second dose: 510 mg IV injection, administered 3 to 8 days after the first dose

Frequency: Treatment duration will depend on your iron levels and nutritional status.

Iron Deficiency Anemia Due to Gastrointestinal Bleeding

Initial dose: 510 mg IV injection

Second dose: 510 mg IV injection, administered 3 to 8 days after the first dose

Frequency: Your doctor will monitor your iron levels and may adjust treatment as necessary.

Thalassemia-Related Iron Deficiency Anemia

Initial dose: 510 mg IV injection

Second dose: 510 mg IV injection, administered 3 to 8 days after the first dose

Frequency: Follow-up doses may be required depending on your iron levels and response to treatment.

Dosage Forms and Strengths

Injection: 510 mg/17 mL (30 mg/mL) solution in a single-dose vial

Ferumoxytol Administration Instructions

Ferumoxytol is administered as an intravenous (IV) injection by a healthcare professional. The injection is typically given slowly over at least 15 minutes to minimize the risk of side effects. It’s important to stay well-hydrated and inform your healthcare provider if you experience any unusual symptoms during or after the injection. If you have concerns about your treatment, you can schedule a telemedicine visit with one of our providers.

Ferumoxytol Side Effects and Adverse Reactions

Like all medications, Ferumoxytol can cause side effects. Most are mild, but some may be more serious. Contact your healthcare provider if you experience any of the following:

Common Side Effects (1-10%):

1. Nausea: Feeling nauseous is common but usually resolves on its own.
2. Dizziness: You may feel lightheaded after the injection, so it’s important to rest afterward.
3. Headache: Some patients report mild headaches, which typically go away without treatment.

Less Common Side Effects (0.1-1%):

1. Low blood pressure (hypotension): A sudden drop in blood pressure can occur, especially during the injection. Your healthcare provider will monitor you closely.
2. Swelling or pain at the injection site: Some patients may experience mild swelling or discomfort where the IV was placed.

Rare but Serious Side Effects (<0.1%):

1. Severe allergic reactions (anaphylaxis): Though rare, some patients may experience a life-threatening allergic reaction. Symptoms include difficulty breathing, swelling of the face or throat, and hives. Seek emergency medical help if this occurs.
2. Iron overload: Excess iron can accumulate in the body, leading to complications. Your doctor will monitor your iron levels to prevent this.

Contraindications for Ferumoxytol

A contraindication is a specific situation or condition where a medication should not be used because it may cause harm. If you have any of the following conditions, Ferumoxytol may not be safe for you. Always discuss your medical history with your healthcare provider before starting any new medication.

1. Allergy to Ferumoxytol: If you have had an allergic reaction to Ferumoxytol or any of its ingredients, you should not take this medication. Allergic reactions can range from mild to severe and may include symptoms like rash, itching, swelling, or difficulty breathing.
2. Iron Overload (Hemochromatosis): Ferumoxytol is used to treat iron deficiency, so if you already have too much iron in your body, such as in conditions like hemochromatosis, taking Ferumoxytol could lead to dangerous levels of iron in your blood.
3. Severe Liver Disease: The liver plays a key role in processing iron, and if you have severe liver disease, your body may not be able to handle the additional iron from Ferumoxytol, leading to potential complications.
4. Hypersensitivity to Parenteral Iron Products: If you have had a serious allergic reaction to other injectable iron products, Ferumoxytol may cause a similar reaction and should be avoided.

Drug to Drug Interactions

Ferumoxytol can interact with other medications, potentially altering its effectiveness or increasing the risk of side effects. It’s important to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements.

Oral Iron Supplements

Common oral iron supplements, such as Ferrous sulfate and Ferrous gluconate, can lead to iron overload when taken alongside Ferumoxytol, which may harm your organs. Avoid combining oral iron supplements with Ferumoxytol unless specifically directed by your healthcare provider.

ACE Inhibitors

Medications like Lisinopril and Enalapril, commonly used to treat high blood pressure and heart failure, may increase the risk of low blood pressure (hypotension) when taken with Ferumoxytol. If you are on ACE inhibitors, consult your healthcare provider before starting Ferumoxytol.

Calcium Supplements

Calcium supplements, such as Calcium carbonate and Calcium citrate, can interfere with iron absorption, reducing the effectiveness of Ferumoxytol. It’s best to avoid taking calcium supplements close to the time of your Ferumoxytol injection.

Antacids

Antacids like Maalox and Tums can also reduce iron absorption from Ferumoxytol, diminishing its effectiveness. If you need to take antacids, discuss the timing with your healthcare provider to ensure optimal iron absorption.

Ferumoxytol in Pregnancy

Is it Safe to Take Ferumoxytol During Pregnancy?

Ferumoxytol is classified as a pregnancy category C drug, meaning there is not enough research to confirm its safety during pregnancy. While animal studies have shown some risks, there are no well-controlled studies in pregnant women. If you are pregnant or planning to become pregnant, it’s important to discuss the potential risks and benefits of Ferumoxytol with your healthcare provider. In some cases, the benefits of treating iron deficiency anemia during pregnancy may outweigh the risks. Our telemedicine providers can help you make an informed decision based on your specific health needs.

Ferumoxytol While Breastfeeding

Is it Safe to Take Ferumoxytol While Breastfeeding?

There is limited information on the safety of Ferumoxytol during breastfeeding, and it is unknown whether it passes into breast milk. If you are breastfeeding, it’s essential to weigh the potential benefits of treating iron deficiency anemia against any possible risks to your baby. Consult your healthcare provider before starting Ferumoxytol, and consider scheduling a telemedicine appointment to discuss your options.

Estimated Cost of Ferumoxytol

The estimated cost of a 30-day supply of Ferumoxytol without insurance can vary depending on the pharmacy and location. With a GoodRX coupon, the cost typically ranges from $500 to $700 per dose. Since Ferumoxytol is often administered as an injection in a healthcare setting, additional administration fees may apply. Be sure to check with your pharmacy or healthcare provider for accurate pricing.

Possible Alternatives to Ferumoxytol

If Ferumoxytol is not suitable for you, there are alternative treatments and lifestyle changes that may help manage iron deficiency anemia and related conditions. Always discuss these alternatives with your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to help you explore these options.

Iron Deficiency Anemia

Oral iron supplements, such as Ferrous sulfate or Ferrous gluconate, along with dietary changes to include more iron-rich foods (such as red meat, leafy greens, and fortified cereals), may be effective alternatives to Ferumoxytol for treating iron deficiency anemia.

Chronic Kidney Disease

For patients with chronic kidney disease, Erythropoiesis-stimulating agents (ESAs) like Epoetin alfa (Epogen) or Darbepoetin alfa (Aranesp) can help stimulate red blood cell production. These treatments may be used alongside or as an alternative to Ferumoxytol.

Heart Failure

Managing heart failure with medications such as beta-blockers or ACE inhibitors, along with lifestyle changes like reducing sodium intake and increasing physical activity, may improve symptoms and reduce the need for iron supplementation.

Inflammatory Bowel Disease

Treating underlying inflammation with medications like biologics (Infliximab, Adalimumab) can improve iron absorption and reduce the need for iron supplementation in patients with inflammatory bowel disease.

Cancer-Related Anemia

For cancer-related anemia, treatments may include blood transfusions or ESAs, depending on the type and stage of cancer. Ferumoxytol may be considered in certain cases, but other options should be discussed with your healthcare provider.

Pregnancy-Related Anemia

Oral iron supplements and dietary changes are often the first line of treatment for anemia during pregnancy. In more severe cases, intravenous iron, such as Ferumoxytol, may be necessary to manage iron deficiency anemia.

Dialysis-Related Anemia

ESAs and intravenous iron are commonly used to manage anemia in patients undergoing dialysis. Ferumoxytol may be an option for patients who cannot tolerate other forms of intravenous iron.

Malnutrition

Improving nutritional intake through a balanced diet or supplements can help address anemia caused by malnutrition. In some cases, iron supplementation may be necessary to restore iron levels.

Gastrointestinal Bleeding

Treating the underlying cause of bleeding (such as ulcers or hemorrhoids) is essential. Iron supplementation, including Ferumoxytol, may be needed to restore iron levels in patients with gastrointestinal bleeding.

Thalassemia

Blood transfusions and chelation therapy are common treatments for thalassemia. Iron supplementation is generally not recommended, as it can worsen iron overload in these patients.

Recent Updates on Ferumoxytol Research

Recent studies have focused on the safety and effectiveness of Ferumoxytol in treating iron deficiency anemia in specific patient populations, such as those with chronic kidney disease and inflammatory bowel disease. A 2021 study found that Ferumoxytol was well-tolerated and effective in increasing hemoglobin levels in patients with chronic kidney disease who were intolerant to oral iron supplements. Ongoing research is also exploring the use of Ferumoxytol in combination with other therapies to improve outcomes in patients with complex medical conditions.

As new research emerges, staying informed about the latest findings is important. If you have questions about whether Ferumoxytol is the right treatment for you, our telemedicine providers are available to discuss your options and help you make the best decision for your health.

James Kingsley

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