Notes on Parenteral Vitamines/Hem-Supplements depending on BNF 73

1. REFERENCE:BNF 73 1
I. Iron dextran (50mg/ml)
* contraindicated in history of allergic disorder like asthma & eczema,
infections, active rheumatoid arthritis
* should be avoided in severe hepatic impairment, acute renal failure & 1st
trimester of pregnancy
* oral tratment started least 5 days after last injection
* less commonly associated with flushing, dyspnoea, numbness, cramps,
blurred vision, pruritus & rash
* rarely causes hypotension, angioedema, arrythmias, dizziness, fatigue,
tremor, seizures, impaired consciousness, myalgia, arthralgia & sweating
II. Iron sucrose (20mg/ml)
* countraindicated in history of allergic disorders: asthma, eczema &
anaphylaxis
* used with caution in hepatic impairment (iron overload increases risk) &
should be avoided in pregnancy
* oral tratment started least 5 days after last injection
* associated with taste disturbance & less commonly flushing, dyspnoea,
bronchospasm, dizziness, fever, myalgia, pruritus, rash & injection site
reactions
* rarely causes hypertension, peripheral oedema, anaphylactic reactions,
fatigue, asethnia, arthralgia, confusion & sweating

2. REFERENCE:BNF 73 2
III. Vitamine B6
* sensory neuropathy is reported with high dose (200mg or more daily) or
extended periods regimen
IV. Vitamine B12
* hydroxocobalamine is associated with dizziness, fever, hypersensitivity
reactions, hyokalaemia, thrombocytosis & chromaturia
V. Vitamine K
* The Chief Medical/Nursing Officer recommended that all newborn babies
shoud receive single 1mg I.M injection to prevent vit. K defeciency bleeding
otherwise colloidal preparation given by mouth as 2mg in 1st week ( 1st dose
at birth & 2nd dose at 4-7 days & A 3rd dose at 1month of age for exclusively
breast-fed babies)
* Intravenous injection should be given very slowly
VI. Erythropoietin-α & Methoxy polyethylene glycol
* used in caution with ischemic vascular disease, poorly controlled blood
pressure (dose dependent increase in blood pressure-sudden stabbing
migraine like pain indicate hypertensive crisis, also risk of thrombosis), so
avoidance recommended with recent MI/CVA, generlized tonic-clonic
seizures & encephalopathy like symptoms
* used in caution with chronic hepatic failure
*used in caution with malignant disease (risk of tumour progression), while
in pt. receiving chemotherapy (associated with increased risk thrombosis)
* associated with risk of red cell aplasia-particularly after S.C administration
(contra-indicated; all erythropoetin forms)
* associated with hyperkalemia, hypersensity reactions, skin reaction &
peripheral edema
* no evidence of harm reported during pregnancy neither in breast feeding (
unlikely to present in milk)
* avoided in neonates receiving benzyl alcohol containing injections, also
associated with retinopathy when used in prenature infants
* Hb concentration should be maintained within 10-12g/100ml

3. REFERENCE:BNF 73 3
* Methoxy polyethylene glycol has longer duration of action than
erythroboetin
* Methoxy polyethylene glycol used in caution with pregnancy & breast-
feeding (stated bymanufacturer despite no evidence ofharm & present in milk
in animal-studies respectively)