Consider phosphate levels if symptoms emerge after intravenous iron repletion

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PHARMACOTHERAPY

Consider phosphate levels if symptoms emerge after intravenous iron repletion

29 September 2021

By Linda Bryant

Wednesday 29 September 2021, 12:10 AM

Three weeks after her iron infusion, Janet was feeling tired, achy and weak (Image: Dmitry Schemelev on Unsplash)

There is wide variation in the reported incidence of hypophosphataemia after intravenous iron therapy, and risk factors are debated, but patients should be alerted to the symptoms of tiredness, weakness and muscle pain

Linda Bryant

Key Points, Iron infusion with ferric carboxymaltose is associated with a higher incidence of hypophosphataemia than other formulations. Treatment and monitorin, Pract Green w Pale Yellow

Medicines and Therapies

Investigations

Haematology

References

1. Schaefer B, Tobiasch M, Viveiros A, et al. Hypophosphataemia after treatment of iron deficiency with intravenous ferric carboxymaltose or iron isomaltoside-a systematic review and meta-analysis. Br J Clin Pharmacol 2021;87(5):2256–73.

2. Anand G, Schmid C. Severe hypophosphataemia after intravenous iron administration. BMJ Case Rep 2017;2017:bcr2016219160.

3. Hardy S, Vandemergel X. Intravenous iron administration and hypophosphatemia in clinical practice. Int J Rheumatol 2015;2015:468675.

4. Glaspy JA, Lim-Watson MZ, Libre MA, et al. Hypophosphatemia associated with intravenous iron therapies for iron deficiency anemia: A systematic literature review. Ther Clin Risk Manag 2020;16:245–59.

5. Stoffel NU, Cercamondi CI, Brittenham G, et al. Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials. Lancet Haematol 2017;4(11):e524–33.

6. Bulbuz A, Mino E, Dake V, et al. Alternate day oral iron dosing in iron deficiency anemia. Blood 2018;132(Suppl 1):4891.

7. Stoffel N, Zeder C, Brittenham G, et al. Iron absorption from supplements is greater with alternate day than consecutive day dosing in iron-deficient women. Haematologica 2020;105:1232–39.

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