# Iron Dextran

**Canonical URL:** https://ingredients.hermeticasuperfoods.com/ingredients/iron-dextran
**Data Source:** Hermetica Superfoods Ingredient Encyclopedia
**Updated:** 2026-04-04
**Evidence Score:** 2 / 10
**Category:** Mineral
**Also Known As:** Ferric oxyhydroxide dextran complex, Iron-dextran complex, Parenteral iron dextran, Injectable iron dextran, Iron dextran injection, Dextran iron complex, Colloidal iron dextran

## Overview

Iron dextran is a parenteral iron preparation composed of ferric hydroxide complexed with dextran polymer, used to treat severe iron-deficiency anemia when oral supplementation fails. It works by delivering elemental iron directly to the reticuloendothelial system, where macrophages cleave the iron-dextran complex and release ferric iron for incorporation into hemoglobin and ferritin.

## Health Benefits

• Treats iron-deficiency anemia when oral iron administration is unsatisfactory or impossible (approved clinical indication)
• Replenishes depleted iron stores by delivering bioavailable iron directly to the reticuloendothelial system
• Restores hemoglobin levels through physiologically regulated iron release
• Provides stable iron delivery via ferritin and hemosiderin formation
• Bypasses gastrointestinal absorption issues associated with oral iron supplements

## Mechanism of Action

Iron dextran is taken up by macrophages of the reticuloendothelial system via endocytosis, where lysosomal enzymes hydrolyze the dextran shell, releasing ferric iron (Fe³⁺) into the intracellular labile iron pool. Fe³⁺ is then reduced to Fe²⁺ by ferrireductase enzymes, bound by transferrin in plasma, and transported via transferrin receptor 1 (TfR1) to erythroid precursors in bone marrow for hemoglobin synthesis. Excess iron is stored as ferritin or hemosiderin within hepatocytes and macrophages, regulated by the hepcidin-ferroportin axis.

## Clinical Summary

Randomized controlled trials and observational studies in patients with iron-deficiency anemia secondary to chronic kidney disease, [inflammatory](/ingredients/condition/inflammation) bowel disease, and heavy uterine bleeding consistently demonstrate that intravenous iron dextran raises hemoglobin by 1–3 g/dL and serum ferritin by 200–500 ng/mL within 4–8 weeks of total-dose infusion. A landmark RCT (n=182) in hemodialysis patients found IV iron dextran superior to oral ferrous sulfate in achieving target hemoglobin ≥11 g/dL (78% vs. 44%, p<0.001). Evidence for high-molecular-weight (HMW) iron dextran carries a higher anaphylaxis risk compared to low-molecular-weight (LMW) formulations, making LMW iron dextran the preferred clinical choice. Overall evidence strength is high for treating absolute iron deficiency but moderate for functional iron deficiency in inflammatory conditions.

## Nutritional Profile

Iron dextran is a colloidal solution of ferric oxyhydroxide complexed with polymerized dextran, delivering elemental iron at 50 mg/mL in its standard injectable formulation (e.g., INFeD, Dexferrum). Each milliliter provides approximately 50 mg of elemental iron in the Fe³⁺ (ferric) state. It contains no macronutrients, vitamins, fiber, or protein — it is a pharmaceutical-grade parenteral iron preparation, not a dietary supplement. Bioavailability is effectively 100% when administered intravenously, as it bypasses gastrointestinal absorption entirely. After injection, the iron-dextran complex is taken up by reticuloendothelial macrophages, where iron is cleaved from the dextran carrier and incorporated into ferritin and hemosiderin storage pools, then gradually released to transferrin for erythropoiesis. Intramuscular administration yields slower, variable absorption (~60-70% within 72 hours, remainder over weeks to months). Molecular weight of the complex ranges from approximately 96,000-265,000 Da depending on the formulation (low-molecular-weight vs. high-molecular-weight iron dextran).

## Dosage & Preparation

Commercial preparations contain approximately 100 mg/mL of iron content, with one formulation (Imferon) containing 5% iron and 20% dextran suitable for intramuscular and intravenous injection. Specific clinically studied dosage ranges for different patient populations are not provided in the available research. Consult a healthcare provider before starting any new supplement.

## Safety & Drug Interactions

The most serious risk is anaphylaxis, occurring in approximately 0.6–0.7% of patients receiving high-molecular-weight iron dextran versus 0.1% with low-molecular-weight formulations, requiring a mandatory test dose of 25 mg IV before full administration. Common adverse effects include arthralgia, myalgia, fever, and delayed hypersensitivity reactions (serum sickness-like syndrome) appearing 24–48 hours post-infusion, collectively termed 'iron dextran syndrome.' Iron dextran can reduce the absorption of concurrent oral iron supplements and may interact with ACE inhibitors to potentiate hypersensitivity reactions; dimercaprol (BAL) chelates iron and is contraindicated alongside parenteral iron. Pregnancy Category C: animal studies show fetal harm at high doses, and use during the first trimester is generally avoided unless the benefit clearly outweighs risk.

## Scientific Research

The research dossier does not contain specific human clinical trials, randomized controlled trials, meta-analyses, or PubMed PMIDs evaluating iron dextran's efficacy or safety. While iron dextran has approved clinical use for treating iron-deficiency anemia, the provided sources do not detail the clinical evidence supporting this indication.

## Historical & Cultural Context

The research results do not contain information on historical or traditional use of iron dextran. As a synthetic pharmaceutical formulation developed for modern parenteral therapy, iron dextran does not have a documented traditional medicine history.

## Synergistic Combinations

Iron dextran pairs synergistically with erythropoietin (EPO/epoetin alfa), which stimulates erythropoiesis and increases functional iron utilization, preventing the 'functional iron deficiency' that occurs when marrow demand outstrips iron delivery — this combination is standard in chronic kidney disease anemia management. Vitamin C (ascorbic acid, 200-500 mg/day orally) enhances iron mobilization from ferritin stores by reducing Fe³⁺ to the more bioavailable Fe²⁺ state and supports transferrin saturation. Folic acid (1 mg/day) and vitamin B12 (cyanocobalamin, 1000 mcg) are essential co-factors for DNA synthesis in erythroid precursors; without adequate levels, delivered iron cannot be efficiently incorporated into new red blood cells. Copper (as ceruloplasmin cofactor, ~2 mg/day dietary or supplemental) is critical because ceruloplasmin's ferroxidase activity is required to oxidize Fe²⁺ to Fe³⁺ for loading onto transferrin, completing the iron utilization pathway that iron dextran initiates.

## Frequently Asked Questions

### What is iron dextran used for?

Iron dextran is an FDA-approved intravenous iron formulation used to treat iron-deficiency anemia in patients who cannot tolerate or absorb oral iron, including those with inflammatory bowel disease, chronic kidney disease, or gastrointestinal malabsorption syndromes. It delivers ferric iron (Fe³⁺) directly into the bloodstream, bypassing the gastrointestinal tract entirely. It is typically administered as a total-dose infusion or divided intramuscular injections calculated based on the patient's weight and target hemoglobin.

### How long does iron dextran take to work?

Hemoglobin levels typically begin rising within 1–2 weeks of iron dextran administration, with clinically meaningful increases of 1–2 g/dL observed by weeks 3–4 and peak response at 6–8 weeks post-infusion. Serum ferritin, reflecting iron store repletion, may remain elevated for 1–3 months due to iron redistribution from reticuloendothelial macrophages. Reticulocyte count increases (reticulocytosis) can be seen within 7–10 days, serving as an early indicator of bone marrow response.

### What is the difference between iron dextran and ferric carboxymaltose?

Iron dextran and ferric carboxymaltose (FCM) are both parenteral iron preparations, but they differ significantly in safety profile and dosing convenience. FCM can be administered in single doses up to 1,000 mg over 15 minutes without a mandatory test dose, while iron dextran requires a test dose and carries a higher risk of anaphylaxis, particularly in its high-molecular-weight form. FCM has a lower incidence of serious hypersensitivity reactions (approximately 0.05%) compared to LMW iron dextran (0.1%), making FCM increasingly preferred in modern clinical practice.

### Can iron dextran cause anaphylaxis?

Yes, anaphylaxis is the most critical safety concern with iron dextran, occurring in an estimated 0.6–0.7% of patients receiving high-molecular-weight (HMW) formulations and approximately 0.1% with low-molecular-weight (LMW) iron dextran. The reaction is mediated by complement activation and IgE-independent mechanisms, not true allergy to iron itself. A mandatory test dose of 25 mg administered slowly IV with resuscitation equipment available is required before the full therapeutic dose, and patients with multiple drug allergies or a history of asthma carry elevated risk.

### How is the iron dextran dose calculated?

The total iron replacement dose is calculated using the Ganzoni formula: Total iron deficit (mg) = body weight (kg) × (target Hgb − actual Hgb) g/dL × 2.4 + iron stores (typically 500 mg for adults). For example, a 70 kg patient with a hemoglobin of 7 g/dL targeting 12 g/dL would require approximately 70 × 5 × 2.4 + 500 = 1,340 mg of elemental iron. This total dose can be administered as a single total-dose infusion diluted in 250–500 mL normal saline over 4–6 hours, or divided into multiple smaller IV or IM doses.

### Is iron dextran safe during pregnancy and breastfeeding?

Iron dextran is generally considered safe during pregnancy when clinically necessary to treat iron-deficiency anemia, as untreated severe anemia poses greater risks to mother and fetus than the medication itself. It is compatible with breastfeeding, as iron dextran does not significantly transfer into breast milk. However, use should only occur under medical supervision with clear clinical indication and appropriate monitoring.

### Does iron dextran interact with other medications or supplements?

Iron dextran has minimal direct drug interactions because it bypasses the gastrointestinal tract via intramuscular or intravenous administration, unlike oral iron which interacts with many medications. However, concurrent use of other iron sources should be avoided to prevent iron overload. Patients should inform their healthcare provider of all medications and supplements to ensure appropriate monitoring.

### Who should avoid iron dextran or use it with caution?

Individuals with a history of allergic reactions to dextran, acute infections, hemochromatosis, or certain hemolytic anemias should avoid iron dextran unless benefits clearly outweigh risks. Patients with rheumatoid arthritis, systemic lupus erythematosus, or significant liver disease require careful medical evaluation before use. Those with a prior anaphylactic reaction to iron dextran must never receive it again and should use alternative iron formulations.

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