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Published in Caroline Ashley, Aileen Dunleavy, John Cunningham, The Renal Drug Handbook, 2018
Caroline Ashley, Aileen Dunleavy, John Cunningham
After intravenous infusion, iron sucrose is taken up by the cells of the reticuloendothelial cells, particularly in the liver and spleen. The reticuloendothelial cells gradually separate iron from the iron-sucrose complex. Most absorbed iron is bound to transferrin and transported to the bone marrow where it is incorporated into haemoglobin; the remainder is contained within the storage forms, ferritin or haemosiderin, or as myoglobin, with smaller amounts occurring in haem-containing enzymes or in plasma bound to transferrin.
Management of Trace Elements in Short Bowel Syndrome
Published in John K. DiBaise, Carol Rees Parrish, Jon S. Thompson, Short Bowel Syndrome Practical Approach to Management, 2017
Patients who are unable to absorb sufficient iron via the oral route due to SBS or inadequate contact of enteral nutrients with the duodenum can receive periodic iron infusions [35,36]. Older parenteral iron preparations, such as iron dextran, had the disadvantage of the risk of anaphylactic reactions associated with dextran [31]. Newer parenteral iron products, such as iron sucrose, are rarely associated with serious adverse events, but less serious infusion reactions (that are still concerning to patients) have been reported. Parenteral iron is usually administered in a supervised setting or infusion center rather than at home [31,32,36]. Because parenteral iron bypasses absorption through the gut and with no routine mechanism for excretion of excess, iron provided beyond needs can be deposited in hepatic, renal, and cardiac tissue [31]. If excess parenteral iron is provided over an extended period of time, iron deposition in the heart, liver, and/or kidney may be complicated by eventual organ failure [31].
Inflammatory Bowel Disease
Published in Mary J. Marian, Gerard E. Mullin, Integrating Nutrition Into Practice, 2017
Interestingly, oral iron supplementation has been associated with inflammation in the intestines in animal models due to the production of reactive oxygen species [168]. Intravenous iron may be the preferred method of repletion for IBD patients, especially in those with severe deficiency [169]. However, intravenous iron does carry the risk of infusion reactions and anaphylaxis. A newer intravenous iron has been developed, called ferric carboxymaltose, which can be safely administered at higher doses and therefore decrease the number of infusions needed. A multicenter trial found it superior to traditional iron sucrose in regard to efficacy in increasing hemoglobin levels and patient compliance [170]. Iron therapy is relatively contraindicated during active infections such as abscesses. Table 15.3 summarizes the most common vitamin and mineral deficiencies in IBD patients, the daily recommended dose, and foods that contain these vitamins.
Letter to the editor regarding ‘A systemic review and meta-analysis on the efficacy and safety of ferumoxytol for anemia in chronic kidney disease patients’
Published in Renal Failure, 2023
Another similar problem could be found in another 2 articles written by Strauss et al. [4] and Macdougall et al. [5]. In these two studies, two clinical trials comparing the efficacy and safety of ferumoxytol with iron sucrose for the treatment of Iron deficiency anemia (IDA) were analyzed and one of them shared the same clinical trial with Macdougall’s (ClinicalTrials.gov identifier: NCT01052779). In Strauss’s study, the authors performed their study using 2 completed clinical trials. In the first trial, researchers assessed the safety and efficacy of ferumoxytol with iron sucrose for the treatment of IDA in CKD adult patients with or without dialysis. In the second one, patients with any unexplained IDA and a history of unsatisfactory or inability to receive oral iron therapy were selected. The first trial was registered with an identifier of NCT01052779. Meanwhile, in Macdougall’s research, both hemodialysis and non-dialysis patients assigned to ferumoxytol received two IV injections of 510 mg (17 mL; no faster than over 17 s) within 563 days for an accumulative dose of 1.02 g. This randomized, open-label, multicenter, international, phase 2 trial shared the same clinical trial number as Strauss’s study, also known as NCT01052779. Consequently, these data were analyzed repeatedly in this meta-analysis.
Observations from a peculiar case of volatile substance dependence–A case report
Published in Journal of Addictive Diseases, 2020
Dhruv Bardolia, Urvika Parikh, Saumitra Nemlekar, Rajat Oswal
In view of the severe iron deficiency, a parenteral iron preparation was prescribed. She was treated with Injection Iron Sucrose 200 mg intravenously. For her depressive symptoms we started her on Sertraline 25 mg and Clonazepam 0.5 mg for sleep. We observed for any risk of bleeding tendencies inherent with the use of selective serotonin reuptake inhibitors (SSRIs). She received a set of five infusions of parenteral iron over a period of two weeks. After eight weeks she reported significant clinical improvement, with no depression as per the HAM D scale (HAM-D score = 8). With parenteral iron therapy her hemoglobin had improved to 8.8 gm/dL (12.0–15.0 g/dL)/5.5 mmol/L (7.45–9.30 mmol/L). She reported no craving for the use of inhalants. This coincided with the correction of anemia and marked improvement in her depressive features. Patient was further advised to come for regular follow ups. The plan of action was to provide supportive care and cognitive behavior therapy to maintain the abstinence. She was counseled for healthy dietary practices.
Hepcidin as a therapeutic target for anemia and inflammation associated with chronic kidney disease
Published in Expert Opinion on Therapeutic Targets, 2019
Jolanta Malyszko, Jacek S. Malyszko, Joanna Matuszkiewicz-Rowinska
For efficient erythropoiesis, both iron and erythropoietin are required to make the perfect match. Therefore, both iron and ESA preparations are used successfully to treat renal anemia. In addition to innovative ESAs, biosimilar biologic agents have emerged for the treatment of anemia in many countries [74,75]. The advantage of biosimilar drugs is that they are significantly less expensive than the reference products, allowing for increased accessibility and cost savings. Additionally, competition in the marketplace will likely decrease the cost of the reference agent as well. The uptake by the nephrology community of biosimilar ESAs will depend on the balance between cost savings and any residual concerns regarding their safety. Several iron sucrose similar (ISS) preparations have been introduced for the treatment of iron deficiency anemia in a number of countries worldwide on the basis that they can be considered therapeutically equivalent to the originator i.v. iron sucrose-IS. However, as shown by Rottembourg et al. [76] the switch from the originator IS to an ISS preparation led to the destabilization of a well-controlled population of HD patients and incurred an increase in total anemia drug costs. Concluding, more detailed cost-benefit analyses of iron and ESA therapies would also be welcome.