Ferumoxytol for the treatment of iron deficiency

Intravenous iron is standard for dialysis-associated anemia and its use is rising dramatically in other settings. Except for the dextrans, full iron replacement requires multiple visits. Nonetheless, safety concerns abound. Ferumoxytol, a recently approved modified dextran with a carbohydrate core that tightly binds the iron moiety, decreasing free iron and ostensibly increasing safety, was approved by the US FDA, in June 2009, for the treatment of iron deficiency associated with chronic kidney disease and end-stage renal disease. This formulation, uniquely, can be administered in a large dose as a short intravenous injection of 1 min or less, markedly facilitating care. Recent post-marketing safety issues have been raised resulting in a change in the package insert. This article examines existing clinical data and posits reasons for the labeling change. Potential future use of this formulation is opined.