Monitoring for adverse effects of intravenous iron supplementation

Intravenous iron supplementation is well tolerated. Patients and staff administering intravenous iron supplementation should be informed of potential adverse effects and the likely timeframe in which they may occur.

Inform the patient of the possibility of iron staining of the skin if there is extravasation of intravenous iron during administration. This can result in permanent skin discolouration Canning, 2020. The doctor or nurse administering the intravenous iron supplementation should be educated to observe the patient for needle site tissuing, or pain or swelling at the administration site—if any of these symptoms occur the intravenous iron supplementation should be stopped immediatelyCanning, 2020.

All intravenous iron preparations have a very small risk of causing anaphylaxis; ensure adrenaline (epinephrine) is available for prompt administration, and that the intravenous iron supplementation is administered by staff trained in the management of anaphylaxis. For the emergency management of anaphylaxis, see the Australian Prescriber wallchart, available to download in the Anaphylaxis topic.

Some patients may experience flushing, dizziness or light-headedness within the first few minutes of starting the intravenous iron supplementation. This is usually self-limiting and generally only lasts a few minutesRichards, 2021. Stop the supplementation until the symptoms subside, reassure the patient that the effects are self-limiting, and then restart the intravenous iron supplementation at a lower rateRichards, 2021.

A small proportion of people develop influenza-like symptoms a few days after the intravenous iron supplementation. These symptoms are usually self-limiting but can persist for 24 to 48 hoursRichards, 2021.

Transient hypophosphataemia has been reported 5 to 20 days after intravenous iron supplementation (especially ferric carboxymaltose)Richards, 2021. The incidence is unknown because the severity of symptoms can vary. Inform the patient about the risk of hypophosphataemia—it can cause significant illnessBlazevic, 2014. Hypophosphataemia secondary to intravenous iron supplementation is more likely in patients with kidney impairment. If a patient complains of feeling unwell following intravenous iron supplementation, it is appropriate to measure their serum phosphate concentration. Rarely, repeated intravenous iron supplementation has been associated with the development of hypophosphataemic osteomalaciaBishay, 2017.