Do IV Iron Agents Release Free Iron?
Concern that parenteral iron-carbohydrate compounds release free iron is neither new nor confined to a single iron agent. In the mid-1960s, examination of iron dextran Imferon by polarography and high-voltage electrophoresis suggested that 0.3% of the total iron in the compound consists of ionic iron in the ferrous (Fe+2) state, probably weakly bound to dextran (1). These investigators were the first to predict that a small fraction of weakly bound or labile iron could provoke iron-mediated hypotension if large doses were injected rapidly. Subsequent efforts to identify free, ionic iron in iron-carbohydrate agents have proved unsuccessful. No dialyzable iron has been found in iron dextran (2,3), ferric gluconate (4), or iron sucrose (5). The product package insert for ferric gluconate reports that <1% of iron in ferric gluconate is dialyzable in vitro (6). Neither iron sucrose nor iron dextran release detectable iron to dialysate using high-flux or high-efficiency dialyzers (7). Eviden
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