Ferric derisomaltose is a form of iron administered intravenously to address iron deficiency anemia. This treatment is designed for individuals who cannot take iron by mouth or have not responded well to oral iron supplements. It functions as an iron replacement product, replenishing the body’s iron stores so it can produce a sufficient number of healthy red blood cells.
Iron’s Role and Iron Deficiency Anemia
Iron is a mineral that has many functions, most notably producing hemoglobin, the protein in red blood cells that transports oxygen from the lungs to the rest of the body. This oxygen transport is necessary for generating energy for daily activities. Iron is also a component of myoglobin, which stores oxygen in muscles, and is involved in immune function and the synthesis of some hormones.
When the body’s iron stores become too low, iron deficiency occurs. This can happen due to insufficient dietary iron, chronic blood loss, pregnancy, or issues with absorbing iron from food. Common symptoms include persistent fatigue, weakness, pale skin, shortness of breath, and dizziness. Some individuals may also experience hair loss or brittle nails.
If left unaddressed, iron deficiency can progress to iron deficiency anemia, a state where the lack of iron impairs the body’s ability to produce enough hemoglobin. This reduction in oxygen-carrying capacity leads to more pronounced symptoms. In children, this condition can impact growth and brain development.
Ferric Derisomaltose: Composition and Action
Ferric derisomaltose is a complex molecule composed of iron (III) hydroxide and a carbohydrate shell called derisomaltose. This stable structure allows for the administration of a high dose of iron in a single infusion while minimizing the release of free, unbound iron into the bloodstream. The carbohydrate shell encases the iron, forming a matrix that controls its release.
Once infused, this iron-carbohydrate complex is taken up by cells of the reticuloendothelial system, primarily in the liver and spleen. Inside these cells, the iron is gradually released from the derisomaltose shell. The newly freed iron can then bind to transferrin, a protein that transports iron through the blood to the bone marrow.
In the bone marrow, the iron is incorporated into new red blood cells as part of hemoglobin. Excess iron can also be stored in the liver in the form of ferritin, creating a reserve that the body can draw upon. This controlled release mechanism ensures a steady supply of iron for red blood cell production.
Clinical Applications of Ferric Derisomaltose
Healthcare providers turn to ferric derisomaltose when other methods of iron supplementation are not viable. It is a primary treatment for adults with iron deficiency anemia who cannot tolerate oral iron supplements due to gastrointestinal side effects, such as nausea or constipation, or for patients who have not shown a satisfactory improvement after taking oral iron.
Certain medical conditions necessitate a rapid increase in iron levels, making intravenous administration a preferred option. This includes patients with non-hemodialysis dependent chronic kidney disease, who often struggle with iron absorption and chronic inflammation. Intravenous iron may also be used before major surgery to build up iron stores or in patients with inflammatory bowel diseases like Crohn’s disease, where gut inflammation can impair iron absorption.
Receiving Ferric Derisomaltose Treatment
The administration of ferric derisomaltose occurs in a clinical setting, such as a hospital or infusion center. Before the treatment, a healthcare provider will confirm the diagnosis of iron deficiency anemia through blood tests. Patients are also questioned about any history of allergic reactions to other intravenous iron products.
The treatment itself involves an intravenous infusion. A healthcare professional will insert a needle into a vein, and the ferric derisomaltose solution, diluted in a saline bag, is administered into the bloodstream. A standard 1,000 mg dose is infused over a period of at least 20 minutes.
During the infusion, medical staff monitor the patient for any immediate reactions. After the infusion is complete, there is an observation period of at least 30 minutes to watch for any signs of a hypersensitivity reaction. This monitoring ensures patient safety.
Understanding Potential Side Effects and Reactions
Like all medications, ferric derisomaltose carries a risk of side effects. The most commonly reported ones are mild and can include nausea, rash, and headaches. Some patients may experience dizziness or flushing, where the skin becomes red and warm. Reactions at the injection site, such as pain or swelling, can also occur but resolve within a few days.
A more specific, though not severe, reaction known as a Fishbane reaction can happen. It is characterized by temporary flushing, back and chest tightness, and joint pain, and these symptoms usually subside on their own. A rare risk is skin staining, which can happen if the medication leaks out of the vein into the surrounding tissue, a process called extravasation.
Serious hypersensitivity reactions, including anaphylaxis, are a potential risk with any intravenous iron product. Symptoms of a severe reaction include:
- Hives
- Swelling of the face or throat
- Difficulty breathing
- A sharp drop in blood pressure
Because of this risk, the infusion is always administered in a medical facility where staff are trained and equipped to manage such emergencies immediately.