Manageable Side Effects of Intravenous Iron in a Community Practice

Our community hematology oncology practice uses intravenous (IV) iron in a wide variety of patients. A review of the literature on the adverse events (AE) of IV iron found 0.0–32.0% of patients were experiencing an AE with 0.0–0.5 events per patient. In our experience with IV iron, we felt that the actual incidence of AE was much higher than reported. Between June 2006 and April 2007, 156 patient surveys were completed by a total of 120 patients. Surveys were given to patients who had received IV iron in the past week. Those who experience adverse events were asked to note the type, onset, duration and intervention used to alleviate symptoms. Six patients were excluded for reporting symptoms occurring prior to treatment or completing the survey immediately after IV iron treatment. Of the remaining patients, 100 were female and 14 were male with an average age of 48.9 years (17–95 years). Eighty-six patients received iron sucrose, 22 sodium ferric gluconate and 6 iron dextran (InFed). In our patients, 48.2% experienced at least one AE with an average of 1.3 symptoms per patient (see table). The majority of these events (94.5%) were delayed and mild or moderate with only 5.5% of patients requiring a visit to the hospital or physician’s office. Common side effects were muscle or bone aches, dizziness, numbness, tingling and swelling of the hands and feet, abdominal pain and nausea/vomitting. There was no statistically significant difference in the number or severity of AE related to the different preparations. In our experience, AE occur at an increased frequency compared to the published literature. We feel it is important for health care providers to be aware that AE are likely to occur, but that they are usually minor and quite manageable without the need for physician intervention. In our practice the nurses trained in chemotherapy are well equipped to handle most events that arise. We find IV iron to be an extremely useful treatment for patients suffering from both absolute and functional iron deficiency and offer this data as evidence that parenteral iron is safe in a wide variety of patients. Comparison of AE Iron Sucrose n=86 Sodium Ferric Gluconate n=22 Iron Dextran n=6 Our Study n=114 Previously Reported Muscle or bone aches 17.4% 22.7% 50.0% 20.2% 0.0–3.8% Dizzy/Lightheadedness 16.3% 22.7% 33.3% 18.4% 0.0–0.9% Numbness/Tingling in hands/feet 14.0% 9.1% 16.7% 13.2% N/A Swelling in hands/feet 12.8% 13.6% 16.7% 13.2% 0.0–12.9% Stomach pain/cramping 10.5% 18.2% 16.7% 12.3% 0.0–4.5% Nausea/vomiting 10.5% 13.6% 16.7% 11.4% 0.0–25% Itching 10.5% 4.5% 16.7% 9.6% 0.0–1.5% Chest tightness/discomfort 4.7% 9.1% 0.0% 5.3% 0.0–1.0% Shortness of breath 3.5% 13.6% 0.0% 5.3% 0.0–1.5% Facial Flushing 3.5% 0.0% 0.0% 2.6% 0.0–.3% Hives 1.2% 4.5% 0.0% 1.8% 0.0–6.45% Other 12.8% 13.6% 50.0% 14.9% 0.0–30.0% Any symptom 44.2% 59.1% 66.7% 48.2% 0.0–32.26% Total symptoms 1.2 symptoms/patient 1.5 symptoms/patient 2.2 symptoms/patient 1.3 symptoms/patient 0.0–.45 symptoms/patient