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Published Online, 15 November 2005, www.theannals.com, DOI 10.1345/aph.1G310.
 The Annals of Pharmacotherapy: Vol. 39, No. 12, pp. 2124-2127. DOI 10.1345/aph.1G310
© 2005 Harvey Whitney Books Company.
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Acute Hypersensitivity Reaction to Ferric Gluconate in a Premedicated Patient

Claire E Saadeh, PharmD1, and Gordan Srkalovic, MD PhD2

1 Associate Professor, Pharmacy Practice, Ferris State University; Department of Pharmacy, Sparrow Health System, Lansing, MI
2 Chief, Medical Oncology and Director, Clinical Trials Office, Sparrow Regional Cancer Center; Clinical Associate Professor, College of Human Medicine, Michigan State University, Lansing

Reprints: Dr. Saadeh, Sparrow Health System, Department of Pharmacy, 1215 E. Michigan Ave., Lansing, MI 48912-7980, fax 517/364-2088, saadehc{at}ferris.edu

OBJECTIVE: To report a case of an acute hypersensitivity reaction to ferric gluconate in a patient premedicated with dexamethasone, diphenhydramine, and prochlorperazine.

CASE SUMMARY: A 38-year-old female with persistent iron deficiency anemia was initiated on parenteral iron therapy with ferric gluconate 125 mg intravenously over 10 minutes. The patient initially tolerated this first dose well; however, she later experienced nausea, dizziness, and minor tongue swelling. On her second course of therapy, the woman was premedicated with dexamethasone, diphenhydramine, and prochlorperazine prior to the same dose of ferric gluconate infused over 30 minutes. Subsequently, the patient developed epigastric pain, nausea, swelling of her lips and tongue, and hypotension. The symptoms abated after administration of diphenhydramine, dexamethasone, morphine, cimetidine, intravenous fluids, and oxygen. She was discharged after a short stay in the emergency department observation unit.

DISCUSSION: Data are limited on the relative safety of ferric gluconate compared with iron dextran. Ferric gluconate does not appear to be associated with severe life-threatening events; however, the possibility of an acute hypersensitivity reaction with this product does exist. In this case, use of the Naranjo probability scale indicated a probable relationship between the hypersensitivity reaction and ferric gluconate.

CONCLUSIONS: Healthcare professionals should be aware of this serious but rare event and encouraged to further document and report these events.

Key Words: parenteral iron therapy, sodium ferric gluconate

Published Online, November 15, 2005. www.theannals.com, DOI 10.1345/aph.1G310




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