[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Antianaemia agents (iron, folic acid, vitamin B12)](https://durgical.com/en/pharmacology/classes/antianaemia-agents/) › Iron dextran

# 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.

Updated Nov 1, 2026

## Quick facts

**Group**
[Antianaemia agents (iron, folic acid, vitamin B12)](https://durgical.com/en/pharmacology/classes/antianaemia-agents/)

**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.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

◆**Transferrin, the plasma iron carrier (iron is built into haemoglobin)**Iron dextran

ⓘ 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.

**Target in 3D:** Transferrin, the plasma iron carrier (iron is built into haemoglobin). PDB structure 3QYT (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/3QYT) · Drag to rotate · pinch to zoom

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 →](https://durgical.com/en/conditions/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

### Serious (rare, important)

- Anaphylaxis, which can be fatal even after a tolerated test dose
- Chest pain or tightness, blood in the urine

## 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

## Memory aid

«DEXtran = Dangerous EXcept with a test dose»: always test first and watch for an hour.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/iron-dextran/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## Connections

## Related drugs 3

- [Ferric carboxymaltose](https://durgical.com/en/pharmacology/ferric-carboxymaltose/)
- [Iron sucrose](https://durgical.com/en/pharmacology/iron-sucrose/)
- [Ferrous sulfate](https://durgical.com/en/pharmacology/ferrous-sulfate/)

## Related conditions 1

- [Iron deficiency anaemia](https://durgical.com/en/conditions/iron-deficiency-anaemia/)

[← Back to the class: Antianaemia agents (iron, folic acid, vitamin B12)](https://durgical.com/en/pharmacology/classes/antianaemia-agents/)

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](https://medlineplus.gov/druginfo/meds/a614033.html) (MedlinePlus (U.S. National Library of Medicine), 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=B03AC&showdescription=no) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/iron-dextran/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/iron-dextran/