Ferric derisomaltose

Name: Ferric derisomaltose

Dosing & Uses

Dosage Forms & Strengths

injectable solution

  • 100mg elemental iron/mL (1-mL, 5-mL, 10-mL single-dose vials)

Iron Deficiency Anemia

Indicated for iron deficiency anemia in adults who have intolerance to oral iron or have had unsatisfactory response to oral iron

Also indicated for iron deficiency anemia in adults who have nonhemodialysis-dependent chronic kidney disease

≥50 kg: 1000 mg IV infusion

Repeat dose if iron deficiency anemia reoccurs

Dose expressed in mg of elemental iron; each mL contains 100 mg of elemental iron

Safety and efficacy not established



Hypersensitivity to ferric derisomaltose or any of its components


Serious hypersensitivity reactions, including anaphylactic-type reactions, some of which have been life-threatening and fatal, reported

Excessive therapy with parenteral iron can lead to excess iron storage and possibly iatrogenic hemosiderosis or hemochromatosis; monitor hematologic response (hemoglobin and hematocrit) and iron parameters (serum ferritin and transferrin saturation) during therapy; do not administer to patients with iron overload

Pregnancy & Lactation


There are no available data on use in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes

Published studies on the use of IV iron products in pregnant women have not reported an association with adverse developmental outcomes; these studies cannot exclude the absence of any drug-related risk during pregnancy because the studies were not designed to assess for the risk of major birth defects

Animal data

  • Iron complexes have been reported to be teratogenic and embryocidal in noniron-depleted pregnant animals
  • Findings in animals may be due to iron overload and may not be applicable to patients with iron deficiency
  • Animal reproduction studies of ferric derisomaltose administered to rats and rabbits during organogenesis caused adverse developmental outcomes including structural abnormalities and embryofetal mortality at doses ~0.09 and 0.4 times the maximum recommended human dose (MRHD) of 1000 mg, respectively, based on body surface area

Clinical considerations

  • Untreated iron deficiency anemia in pregnancy is associated with adverse maternal outcomes (eg, postpartum anemia)
  • Adverse pregnancy outcomes associated with iron deficiency anemia include increased risk for preterm delivery and low birth weight
  • Risks to fetus associated with maternal severe hypersensitivity reactions
  • Severe adverse reactions including circulatory failure (severe hypotension, shock including in the context of anaphylactic reaction) may occur in pregnant women with parenteral iron products which may cause fetal bradycardia, especially during second and third trimester


Available data on use in lactating women demonstrate that iron is present in breast milk

Data do not inform the potential exposure of iron for the breastfed child or the effects on milk production

Consider developmental and health benefits of breastfeeding along with the mother’s clinical need for ferric derisomaltose in addition to any potential adverse effects on the breastfed child from the drug or from the underlying maternal condition

Clinical considerations

  • Monitor breastfed children for gastrointestinal toxicity (constipation, diarrhea)

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.


Mechanism of Action

Ferric derisomaltose is a complex of iron (III) hydroxide and derisomaltose, an iron carbohydrate oligosaccharide that releases iron

Iron binds to transferrin for transport to erythroid precursor cells to be incorporated into hemoglobin


Peak plasma concentration: 408 mcg/mL (single 1000-mg dose)

AUC: 17,730 mcg⋅hr/mL (single 1000-mg dose)

Serum ferritin peaks ~7 days after an IV dose and slowly returns to stable levels after about 4 weeks


Circulating iron is removed from plasma by cells of the reticuloendothelial system

Iron is bound to the available protein moieties to form hemosiderin or ferritin, the physiological storage forms of iron, or to a lesser extent, to the transport molecule transferrin


Half-life: 27 hr (measured by serum total iron)

Owing to the size of the complex, ferric derisomaltose is not excreted by the kidneys

Small quantities of iron are excreted in urine and feces

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