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Infusions of Iron Dextran

Anyone with experience infusing Iron Dextran?

We are infusing this more frequently in the Infusion Center and we are debating the test dose aspect of this treatment.

If a patient requires several doses (infusions) do you only give a test dose with the first infusion and if that is the case, how much time must go by before another test dose is required- is the patient exempt forever if they tolerated a test dose in the past or do you have a specific timeframe established before another test dose is required?

We are trying to establish some guidelines and a few have suggested we administer a test each and every time a patient comes in for Iron Dextran- this was rationalized with the fact that even if a test is tolerated the patient can still experience a severe life-threatening reaction during the infusion or with future test doses/ infusions. Some have argued against test doses with every infusion for the same exact reason- just because they tolerate a test dose doesn't mean the patient will not experience a life-threatening reaction.

Your input is appreciated.

Our out-pt chemo unit dose a

Our out-pt chemo unit does a test dose before every dose of the Iron Dextran.

Valorie Dunn,BSN, RN, CRNI, PLNC

our pharmacy prefers that we

our pharmacy prefers that we give one large dose of the iron dextran over 6-8 hours, with the test dose first. Otherwise if the patient is getting a weekly small dose, we do not give a test dose. If it is less frequent than weekly, we do. I do not think this is based on evidence,but it is what we do.



Gail McCarter, BSN,CRNI

Franklin, NH

Robbin George
Twice in the past several

Twice in the past several months we had an M-set (Code Blue) occurance in our outpatient infusion center

Both patients experienced an adverse reaction to a test dose of Iron Dextran

As a result staff is revisiting the procedure and have put the administration of said drug on hold

Robbin George RN Vascular Access Resource Dept Alexandria Hospital Virginia

Robbin George RN VA-BC

Craig Farris RN CRNI
Iron Dextran

We had similar problems with iron dextran several years ago.  We changed to Ferrlecit (ferric gluconate) and have not trouble since.  My unserstanding is that the reactions are more based on the sugar used instead of the Iron.  heope this helps. Craig

Craig Farris RN, CRNI

Clinical Nurse liaison

Anne Wolkenstein

Our policy states:

"Test Dose:  A test dose is recommended when

-a patient receives his/her first dose if iron dextran

-more that 6 months have elapsed since patient last received IV iron dextran

Note:  a)  the test dose may be given at the beginning of dialysis as reactions can occur up to 1 hour post dose.  The remainder of the dose may be given over the last hour of dialysis.

b) Where possible, the dose should be given during the day shift. 


Test dose:  25 mg for 251-1000 mg doses:  Infuse 25 mg over 15 minutes.  Observe patient for 45 minutes.  If no reaction, infuse remaining solution over 1-3 hours."


Dilute dose in 100 mL NS.


Early Reactions:  anaphylaxis incidence 0.1-0.6%

Hypotentsion with flushing

Test Dose Infusion of iron dextran associated with increased incidence of delayed (1-2 days) reactions including arthralgesias, backache, chills, dizziness, fever, headache, malaise, N an V.


A Wolkenstein RN BN CCN
Educator Medicine Program SOGH

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