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Intravenous iron therapy for patients with anemia 

Why is iron important?

Iron is an essential mineral. It is part of hemoglobin. Hemoglobin carries oxygen in the blood and helps make red blood cells. If you have very little iron, you may have very few red blood cells. This condition is called anemia.

Why does oral iron (in pill form) not work as well as intravenous iron (in the vein)?

Some people may have side effects from oral iron pills, or cannot absorb oral iron into their body. It can also take many months for you to get the same dose of iron from oral iron as you can get from one dose of intravenous (IV) iron (iron given in the vein).

Who should get IV iron?

Health Canada has approved iron to be given in the vein (IV) for people who have iron deficiency anemia and also have kidney disease. However, IV iron has been studied for many conditions “off label.” Your doctor may suggest IV iron for iron deficiency anemia if you have side effects to iron pills, if iron pills have not worked, if you have severe anemia, or if you are going for surgery very soon.

Iron deficiency anemia means:

  • Low red blood cells – hemoglobin level less than 120 g/L (grams per litre).
  • Low iron level – ferritin under 30 μg/L (micrograms per litre), or under 200 μg/L with iron saturation less than 20%.

What are the risks of intravenous iron?

Common side effects (about 1 person in every 20 may have these):

  • low blood pressure (dizziness)
  • muscle cramps
  • joint pain
  • headache
  • injection site swelling
  • chest discomfort
  • nausea, vomiting and/or diarrhea

Serious allergic reactions (rashes, face swelling and wheezing) including anaphylaxis, are rare.

After you get IV iron, you will be watched for 30 minutes to make sure you do not have an allergic reaction or a drop in your blood pressure.

If you have any serious reactions after leaving the clinic, go to your closest emergency department immediately, or call 911.

Before your first dose of IV iron tell your doctor or nurse if you are allergic to any medications, including iron pills.

Which forms of IV iron might I get?

Two products are supplied by Sunnybrook’s pharmacy:

  • iron sucrose (Venofer®)
  • ferumoxytol (Feraheme®).

You and your doctor will talk about which one is right for you.

What if I’m scheduled to go for a MRI while I am getting IV iron?

  • Venofer® does NOT affect magnetic resonance imaging (MRI).
  • Feraheme® can affect MRI for up to 3 months.

If it is possible, you should have your MRI before Feraheme® or wait for 3 months after you get Feraheme®.

X-ray, ultrasound, computed tomography (CT) and other imaging tests are not affected.

If you need a MRI, and you have been treated with Feraheme® in the last 3 months, your doctor may prefer to order one of the above tests instead of an MRI.

How much IV iron do I need?

You may need one to three doses which are given about one week apart. This will depend on how severe your anemia is and which IV iron product your doctor ordered.

  • Venofer® is given in the vein over a 2 hour infusion.
  • Feraheme® is given in the vein over a 15 to 60 minute infusion.

You do not need to take your oral iron pills on the day you get the IV iron.

Do I need to pay for my IV iron and how much does it cost?

You will have to pay for your IV iron. The cost of Venofer® ($145 for a dose of 300 mg) and Feraheme® ($230 for a dose of 510 mg) is very similar (each costs about $0.46 per mg of iron).

This cost includes the fee charged by the pharmacy.

If you have private insurance, Venofer® or Feraheme® may be on the list of covered medications.

If you are covered by the Ontario Drug Benefit (OBD) Plan Program (65+ years old, or with Ontario Works, Trillium or ODSP), ODB may cover some of the cost of IV iron if you have already tried oral iron and your anemia did not get better.

How do I get my supply of IV iron?

You should fill your prescription for IV iron at a Sunnybrook pharmacy, since many community pharmacies may not keep it in stock.

You are responsible for picking up your IV iron medication and bringing it to your appointment.

M1 Outpatient Pharmacy:

  • Call the M1 Outpatient Pharmacy at 416-480-4502 and give them your private insurance or credit card information.
  • Pick up the IV iron from the M1 Pharmacy (open 8:30 am - 4:45 pm Mon-Fri).
  • If you pick up the IV iron before your infusion appointment, store it at room temperature.
  • Bring the IV iron with you on the day you are scheduled to get your infusion.
  • If you pick up your IV iron on the day of your infusion, arrive at the pharmacy at least 15 minutes before your appointment.

If your IV iron is prescribed by an Odette Cancer Centre doctor:

  • Call the Odette Pharmacy at 416-480-4671 and give them your private insurance or credit card information.
  • Pick up your IV iron from the Odette Pharmacy (open 8:30 am - 5:00 pm Mon-Fri).
  • If you pick up the IV iron before your appointment, keep it at room temperature.
  • Bring the IV iron with you on the day you are scheduled to get your infusion.
  • If you pick up your IV iron on the day of your infusion, arrive at the pharmacy at least 15 minutes before your appointment.

What if I’m scheduled for another infusion and need more IV iron?

Call the pharmacy where you had your prescription fi lled at least 2 to 3 days before your next dose, so that it will be ready for you to pick up.

  • M1 Pharmacy: 416-480-4502
  • Odette Pharmacy: 416-480-4671