Intravenous iron therapy for patients with anemia 

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.

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).

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%.

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.

Two products are supplied by Sunnybrook’s pharmacy:

• iron sucrose (Venofer®)
• iron isomaltoside (Monoferric®)

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

• Venofer® does NOT affect magnetic resonance imaging (MRI).
• Monoferric® does NOT affect magnetic resonance imaging (MRI).

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

You may need one or more 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 two-hour infusion.
• Monoferric® is given in the vein over a 30 to 60 minute infusion.

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

You will have to pay for your IV iron. The cost of Venofer® is $145 for a dose of 300 mg and Monoferric® is $274 for a dose of 500mg. Each costs about $0.46 to $0.55 per mg of iron.

This cost includes the fee charged by the pharmacy.

If you have private insurance, Venofer® or Monoferric® 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.

Your IV iron prescription will be filled at a Sunnybrook Pharmacy. 

The IV iron medication will be delivered by pharmacy to your appointment location.

The M1 Outpatient Pharmacy will contact you for payment information (credit card or private insurance).

If you are scheduled for more IV iron, the M1 Outpatient Pharmacy may contact you for payment information.