Ferumoxytol

INTRODUCTION

Indications

Treatment of iron deficiency anemia in adult patients with chronic kidney disease (CKD).

Action

Consists of a superparamagnetic iron oxide coated with a carbohydrate shell; when the iron-carbohydrate complex enters the reticuloendothelial system (RES), iron is released from the iron-carbohydrate complex within macrophages. This iron can either enter the intracellular storage iron pool or be transferred to erythroid precursor cells for incorporation into hemoglobin. Therapeutic Effects: Improvement in anemia in patients with chronic kidney disease.

Adverse Reactions/Side Effects

CNS: dizziness. CV: hypertension, hypotension, peripheral edema. GI: constipation, diarrhea, nausea. Hemat: iron overload. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS AND ANAPHYLACTOID REACTIONS.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Assess any join pain, muscle pain, or unusual fatigue that might indicate iron overload. Attempt to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

Patient/Client-Related Instruction

• Instruct patient and family/caregivers to report severe or prolonged GI problems, such as nausea, diarrhea, and constipation.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability of iron-carbohydrate complex; however, iron is not liberated until incorporation into RES.

Distribution: Taken up by RES.

Metabolism and Excretion: Iron can either become part of intracellular ferritin or be transferred to erythroid precursor cells.

Half-life: 15 hr.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Evidence of iron overload; Anemia not due to iron deficiency; Lactation: Avoid use during breast-feeding.

Use Cautiously in: MRI; Geri: Consider age-related ...