2026 Eastern States Conference

Title: Safety outcomes of intravenous iron therapies: low molecular weight iron dextran versus non-dextran iron products 
 
Authors:  
Adria Pirozzi, PharmD 
Kathleen Hess, PharmD, BCPS 
Christina Dickson, PharmD 
 
Learning Objective:  
Categorize the number and severity of adverse drug reactions of IV dextran versus non-dextran IV iron products.  

Self-Assessment Question:
Which of the following IV iron formulations can be administered as a single, full replacement dose?  
a. Iron sucrose
b. Ferumoxytol
c. Sodium ferric gluconate 
d. Low molecular weight iron dextran 

Background: Iron deficiency anemia is the leading cause of anemia worldwide. The primary objective is to categorize the number and severity of adverse drug reactions of intravenous (IV) low molecular weight iron dextran versus non-dextran IV iron products.  

Methods: A retrospective study was conducted among patients at the Veterans Affairs Maryland Health Care System (VAMHCS) who received intravenous iron formulations—including iron sucrose, sodium ferric gluconate, ferric carboxymaltose, Ferumoxytol, ferric pyrophosphate, or low molecular weight iron dextran—between January 1, 2024, and December 31, 2025. Patients with a documented prior allergy or adverse drug event to any intravenous iron formulation were excluded. Baseline date collected included treatment setting (inpatient or outpatient), allergy history, IV iron formulation and dose administered, and baseline iron studies. Adverse reactions were categorized according to the clinical presentation, severity, and management including medications administered, need for escalation of care, and mortality within 7 days of administration. Descriptive statistics were used to evaluate the primary and secondary study outcomes.

Results: Among 1,230 LMWID infusions, 10 reactions occurred (0.81%) with varying severity (3 mild, 3 moderate, 4 severe). Non‑dextran products had 2 reactions among 208 infusions (0.96%) of mild and moderate severity. Most LMWID reactions occurred in the inpatient setting and adults ≥ 65 years. Hypertension and congestive heart failure were the most common comorbidities among reaction cases, with fewer reactions in patients with COPD. Overall, LMWID demonstrated a low reaction rate comparable to non‑dextran formulations.

Conclusion: This study evaluates the safety of low molecular weight iron dextran (LMWID) versus non-dextran intravenous (IV) iron formulations. It will clarify the number and severity of adverse drug reactions from LMWID and assess whether age, select comorbidities, or treatment setting increase hypersensitivity risk. Results may inform clinical decisions of IV iron formulation. Results suggest LMWID has similar reaction rate to other non-dextran IV iron products.