Iron dextran
Antianaemia agents (iron, folic acid, vitamin B12)
Antianaemia agents (iron, folic acid, vitamin B12)
An older injectable iron (IV or IM) for iron deficiency when oral iron is not possible; it needs a test dose because of anaphylaxis risk.
Quick facts
- Group
- Antianaemia agents (iron, folic acid, vitamin B12)
- Target
- Transferrin, the plasma iron carrier (iron is built into haemoglobin)
- Used for
- Iron deficiency
- Key effects
- Injection-site soreness · Taste changes
- Monitor
- Blood pressure · Haemoglobin and ferritin
- ATC
- B03AC
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows human serum transferrin carrying two ferric iron ions; iron freed from the dextran complex by macrophages travels this way to the marrow.
Iron dextran is a colloid of ferric oxyhydroxide bound to dextran. Macrophages (reticuloendothelial cells) take up the complex, split off the iron and release it to transferrin, which carries it to the marrow for haemoglobin synthesis. Low-molecular-weight preparations are safer than the old high-molecular-weight ones.
- The iron–dextran complex is injected
- Macrophages take it up and split off the iron
- Transferrin carries the iron to the marrow
Indications
- Iron deficiency in people who cannot take or absorb oral iron Iron deficiency anaemia →
Adverse effects
Common
- Injection-site soreness, swelling, brown skin staining
- Taste changes, sweating
- Numbness or tingling in the limbs
- Delayed reaction 1–2 days after a dose: joint or muscle pain, fever, chills, headache, nausea
Contraindications
- Previous hypersensitivity to iron dextran
- Extreme caution in rheumatoid arthritis or other connective tissue disease, asthma, allergy to other iron injections, and the acute phase of an inflammatory illness
Key interactions
- ACE inhibitors
- Raise the risk of an allergic reaction to the injection
- Oral iron
- Adds little during injectable treatment and is usually paused
What is monitored
- Observation for at least 1 hour after the test dose and during the infusion
- Blood pressure, breathing, heart rate
- Haemoglobin and ferritin; treatment is held if ferritin rises into the overload range
Administration and safety
- A test dose comes first, with emergency drugs and equipment at hand
- Given only in a health facility; the infusion is slowed or stopped at the first sign of reaction
- IM injection goes deep into the buttock with a technique that prevents skin staining; the IV route is preferred
- Do not confuse with other IV irons (sucrose, carboxymaltose, gluconate)
Pregnancy and breastfeeding
A pregnancy, plans for it or breastfeeding are reported to the doctor; use is weighed against oral iron and safer IV irons.
Nursing care
- Ask about allergies, asthma, rheumatoid arthritis and ACE inhibitor use
- Observe for at least 1 hour after the test dose
- Teach about the delayed reaction (aches, fever) that may start a day or two later
- Tell the laboratory about the treatment before blood tests
Pharmacokinetics
- Absorption
- Intravenous (preferred) or deep intramuscular injection
- Distribution
- Taken up by the reticuloendothelial system
- Elimination
- Cleared slowly by macrophages; large doses can build up in stores
Test yourself
Think of the answer, then tap the question to see it.
Why is a test dose given before iron dextran?
Because of the risk of anaphylaxis.
Does a tolerated test dose rule out a severe reaction?
No, a severe reaction can still happen.
Which antihypertensive class raises the risk of reaction?
ACE inhibitors.
Connections
← Back to the class: Antianaemia agents (iron, folic acid, vitamin B12)
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Iron Dextran Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2025); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.