Sodium ferric gluconate is an intravenous medication administered to replenish iron stores within the body. It addresses iron-deficiency anemia, a condition characterized by an insufficient number of healthy red blood cells due to low iron levels. Administered directly into the bloodstream, this compound provides the necessary iron for producing hemoglobin, the protein in red blood cells that transports oxygen throughout the body. Its primary application focuses on restoring iron balance in individuals whose bodies struggle to absorb enough iron through dietary or oral supplement routes.
Therapeutic Applications
This medication is primarily used for individuals diagnosed with iron-deficiency anemia who also have chronic kidney disease (CKD), particularly those undergoing hemodialysis. Patients with CKD often experience iron deficiency because their kidneys cannot produce enough erythropoietin, a hormone that stimulates red blood cell production. Hemodialysis itself can contribute to iron loss due to blood retained in the dialyzer and frequent blood sampling. Oral iron supplements are often insufficient or poorly tolerated, making intravenous iron a more effective option.
The brand name for sodium ferric gluconate complex is Ferrlecit, a common form of this iron supplement. It is approved for adults and pediatric patients aged 6 years and older who have CKD and are receiving hemodialysis, typically alongside supplemental epoetin therapy. Epoetin stimulates red blood cell production, increasing the body’s iron demand. Intravenous iron helps ensure adequate iron to respond to epoetin and improve anemia.
Administration Process
Sodium ferric gluconate is administered in a controlled clinical or hospital setting by a healthcare professional. The medication is given intravenously, often through an existing dialysis line. It can be diluted in a saline solution and infused over approximately 60 minutes, or given as a slower, undiluted intravenous injection.
Patients generally receive a series of doses over several weeks. A common treatment course involves administering the medication during eight consecutive dialysis sessions. The typical adult dose is 125 mg of elemental iron per dialysis session, with most patients requiring a cumulative dose of 1000 mg of elemental iron over these eight sessions. Pediatric doses are calculated based on weight, usually 1.5 mg/kg, up to a maximum of 125 mg, infused over one hour during each dialysis session.
Potential Side Effects and Reactions
Patients receiving sodium ferric gluconate may experience various side effects. Common reactions include:
Nausea, vomiting, or diarrhea
Stomach pain or leg cramps
Headache, dizziness, or lightheadedness
Temporary flushing of the skin
Soreness, redness, or bruising at the injection site
More serious reactions warrant immediate medical attention, including hypersensitivity or anaphylactic reactions. Symptoms may include:
Hives or sweating
Severe lower back pain
Wheezing or difficulty breathing
Swelling of the face, throat, tongue, or lips
Sudden drop in blood pressure, fainting, or a rapid or weak pulse
Healthcare professionals monitor patients for at least 30 minutes following each infusion to address any signs of an allergic reaction.
Necessary Precautions and Monitoring
Before starting treatment with sodium ferric gluconate, inform the healthcare provider about your complete medical history. This includes any known allergies to iron injections or other medications, as prior reactions could influence the safety of this therapy. Patients should also disclose if they have conditions involving iron overload, such as hemochromatosis or hemosiderosis, as administering additional iron could be harmful. Iron overload means the body has too much iron stored, which can damage organs over time.
For pregnant individuals, discuss potential benefits and risks with a healthcare provider, as intravenous iron administration may be associated with hypersensitivity reactions that could affect the fetus, including temporary fetal bradycardia. If breastfeeding, discuss this with a healthcare provider, as some formulations contain benzyl alcohol that may be transferred to the infant.
Ongoing monitoring is a routine part of treatment, involving regular blood tests to track iron levels, such as hemoglobin, hematocrit, serum ferritin, and transferrin saturation. These tests help determine if the treatment is effectively addressing the anemia and ensure that iron levels do not become excessively high, preventing iron overload.