IV iron dose should be calculated according to body weight and iron deficit and administered in strict accordance with the posology and method of administration described in the product information for each individual product (note that advice varies between products) Caution is needed with every dose of intravenous iron that is given, even if previous administrations have been well tolerated
IV iron products should only be administered when staff trained to evaluate and manage anaphylactic or anaphylactoid reactions—as well as resuscitation facilities—are immediately available
Patients should be closely monitored for signs of hypersensitivity during and for at least 30 minutes after every administration of an IV iron product. In the event of a hypersensitivity reaction, treatment should be stopped immediately and appropriate management initiated. Report any adverse effects via the Yellow Card Scheme (www.mhra.gov.uk/yellowcard)
Overcorrection of haemoglobin concentration in patients with chronic kidney disease may increase the risk of death and serious cardiovascular events. In patients with cancer, clinical trial data show an unexplained excess mortality and increased risk of tumour progression with erythropoietin treatment, and overcorrection of haemoglobin concentration may increase the risk of thrombosis and related complications.
• Patients should only be treated when symptoms of anaemia are present
• The haemoglobin concentration should be maintained within the range 10-12g/100ml (avoid concentrations higher than 12g/100ml). The haemaglobin concentration should not be increased beyond that which provides adequate control of symptoms of anaemia.
• Treatment of symptomatic anaemia with erythropoeitins in patients with cancer is only licensed for patients receiving chemotherapy.
• The decision to use erythropoietin should be based on an assessment of the benefits and risks for individual patients; blood transfusion may be the preferred treatment for anaemia associated with cancer chemotherapy.
There have been very rare reports of pure red cell aplasia in patients treated with epoetin alfa. These patients should not be switched to another form of erythropoietin.
Drugs designated amber are suitable for shared care arrangements under a shared care protocol.
Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.
These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.
Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.
Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.
Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.
Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.
Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.