Optimising Iron Deficiency Management in Chronic Inflammatory Disease

Chronic inflammation can impact the body’s ability to use iron to make enough red blood cells. Therefore, iron deficiency can occur in chronic conditions like chronic kidney disease, heart failure, inflammatory bowel disease and certain inflammatory conditions. Because of this complex aetiology of iron deficiency in these patients, management of it may present some challenges.

Dr Patrick Coleman, Nephrologist and General Medicine Specialist from NSW, Australia provides practical information regarding iron deficiency, how to best manage these patients. Dr Gary Yu, a GP from Auckland provides an update on the latest changes to the Special Authority for Ferinject.

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    FLUAD® Quad is an unfunded Prescription Medicine. FLUAD® Quad is an inactivated influenza vaccine, with an MF59® Adjuvant, as a suspension for injection in a single-dose glass syringe. PRESENTATION: Each dose contains 60 micrograms/0.5 mL of surface haemagglutinin and neuraminidase from four influenza virus strains INDICATIONS: For active immunisation against seasonal influenza for people 65 years of age and older. CONTRAINDICATIONS: Known severe allergic reactions to any component of the vaccine, except egg proteins; previous dose of any influenza vaccine. ADVERSE EVENTS: Common injection site pain, fatigue and headache. Most of these reactions disappear within 3 days. Rare but serious events include thrombocytopenia; lymphadenopathy; muscular weakness; allergic reactions such as anaphylactic shock, anaphylaxis; encephalomyelitis, Guillain Barré syndrome, neuritis, neuralgia, paraesthesia, convulsions; vasculitis with transient renal involvement; generalised skin reactions; and severe injection-site reactions (extensive limb swelling or cellulitis-like reactions). PRECAUTIONS: Postpone immunisation in patients with acute febrile illness or infection. Antibody responses may not be protective in all vaccines, particularly in immunosuppressed patients. FLUAD® Quad is for intramuscular injection use only. Persons with a history of anaphylaxis to egg should be vaccinated only in medical facilities with staff experienced in recognising and treating anaphylaxis. Co-administration with other vaccines has not been studied. If Guillain-Barré syndrome has occurred within 6 weeks of previous influenza vaccination, consider potential benefits and risks. DOSAGE AND ADMINISTRATION: Gently shake before use; inject a single 0.5 mL dose into the deltoid muscle. Store at 2–8°C; do not freeze; protect from light. Before prescribing, review the FLUAD® Quad Data Sheet at www.medsafe.govt.nz, or from CSL Seqirus (NZ) Ltd, Auckland. FLUAD® and FLUAD® Quad are registered trademarks of Seqirus UK Ltd. 10/24
  

Flucelvax^® Quad is an unfunded Prescription Medicine. Flucelvax^® Quad is an inactivated quadrivalent influenza vaccine, prepared in cell cultures as a suspension for injection, in a single-dose glass syringe. PRESENTATION: Each dose contains 60 micrograms/0.5 mL of surface haemagglutinin and neuraminidase from four influenza virus strains. INDICATIONS: For the prevention of influenza caused by Influenza Virus, types A and B, in adults and children 6 months of age and older. CONTRAINDICATIONS: Known severe allergic reaction (e.g. anaphylaxis) to a previous influenza vaccination or to any component of the vaccine. ADVERSE EVENTS: Local injection site pain, erythema and induration. Systemic headache, fatigue, myalgia, irritability, nausea, upper respiratory tract infection and nasopharyngitis. Post-marketing serious adverse events includes hypersensitivity reactions, anaphylactic shock; paraesthesia, Guillain-Barré syndrome; pruritus, urticaria, or non-specific rash; Extensive swelling of injected limb. PRECAUTIONS: Postpone immunisation in patients with febrile illness or acute infection. A protective immune response may not be elicited in all vaccine recipients, particularly in immunosuppressed patients. If Guillain-Barré syndrome has occurred within 6 weeks of previous influenza vaccination, the decision to give Flucelvax^® Quad should be based on careful consideration of the potential benefits and risks. Treatment and supervision for anaphylactic reactions should be available. Co-administration with other vaccines has not been studied. DOSAGE AND ADMINISTRATION: By intramuscular injection only. Gently shake to produce a clear to slightly opalescent suspension before use. Store at 2–8°C; do not freeze; protect from light. Before prescribing, review the Flucelvax^® Quad Data Sheet (10/2024) www.medsafe.govt.nz, Seqirus Auckland, 0800 502 757. Flucelvax^® Quad is a registered trademark of Seqirus UK Ltd or its affiliates.

FERINJECT^® (ferric carboxymaltose) solution for intravenous (IV) use. Presentation: 10mL vial containing 500mg of iron. Therapeutic Indications: Ferinject^® is indicated for the treatment of iron deficiency when oral iron preparations are ineffective, cannot be used, or there is a clinical need to deliver iron rapidly. The diagnosis must be based on laboratory tests Dosage: The dosage must be calculated individually for each patient and must not be exceeded. Maximum single dose of 1000mg iron per week or 20 mg iron/kg body weight. IV injection: Administer >500mg-1000mg iron over 15 minutes, administer >200-500mg iron at 100mg iron/min. IV infusion: >500mg-1000mg iron over 15 minutes; >200mg-500mg iron over 6 minutes. 100mg-200mg iron over 3 minutes. Contraindications: Hypersensitivity to any of the ingredients; anaemia not attributed to iron deficiency; evidence of iron overload or disturbances in utilisation of iron. Special warnings and precautions for use: Parenteral iron preparations can cause hypersensitivity reactions – monitor patients for 30 minutes after each administration; paravenous leakage can lead to skin discolouration and irritation; iron overload; hypophosphataemia and hypophosphataemic osteomalacia; hepatic impairment; acute or chronic infections; contains sodium; not recommended in children < 14 years; Pregnancy category B3 – not recommended if <16 weeks gestation, monitor unborn baby. Adverse effects: Common: headache, dizziness, hypertension, flushing, nausea, injection/infusion site reactions, hypophosphataemia. Uncommon: hypersensitivity Rare: anaphylactoid reactions. Please review Data Sheet before prescribing, available at www.medsafe.govt.nz or call 0800 996 312 for further information. FERINJECT^® is listed on the HML and is a fully funded Prescription Medicine – special authority criteria apply. Based on data sheet June 2021. FERINJECT^® is a registered trademark of Vifor Pharma Group used under license by Aspen New Zealand, C/O Pharmacy Retailing (NZ) Ltd, Auckland.

  
    GARDASIL® 9 (Human Papillomavirus 9-valent Vaccine, Recombinant) is a Prescription Medicine, funded for males and females aged 9–26 years – Restrictions apply. PRESENTATION: Each 0.5 mL dose contains the following HPV L1 Proteins by type: 6 (30 μg), 11 (40 μg), 16 (60 μg), 18 (40 μg), 31 (20 μg), 33 (20 μg), 45 (20 μg), 52 (20 μg), and 58 (20 μg). INDICATIONS: In 9–45 year-old females for the prevention of cervical, vulvar, vaginal and anal cancer, precancerous or dysplastic lesions, genital warts, and in 9–45 year-old males, for the prevention of anal cancer, precancerous or dysplastic lesions, external genital lesions and infection caused by the HPV types in the vaccine. CONTRAINDICATIONS: Hypersensitivity to any ingredients of GARDASIL® or GARDASIL® 9. Those who develop symptoms indicative of hypersensitivity after receiving a dose should not receive further doses. PRECAUTIONS: Not intended to be used for treatment of active external genital lesions; cervical, vulvar, vaginal or anal cancers; CIN, VIN, VaIN, or AIN. Current or recent febrile illness, impaired immune responsiveness or HIV infection, thrombocytopenia or any coagulation disorder. Observe for 15 minutes after vaccination, in case of syncope or rare anaphylactic reactions. Not recommended for use in pregnancy (Category B2), children younger than 9 years, or elderly patients. Immunisation does not replace the need for regular cervical cancer screening. INTERACTIONS: Systemic immunosuppressive therapies, including corticosteroids, irradiation, antimetabolites, alkylating agents, cytotoxic agents. ADVERSE EVENTS: Injection-site reactions (pain, swelling, erythema, bruising, pruritis, mass, haemorrhage, induration, haematoma, reaction or warmth) and systemic effects (headache, pyrexia, nausea, vomiting, dizziness, fatigue, influenza, diarrhoea, myalgia, arthralgia, asthenia, chills, malaise, oropharyngeal pain, upper abdominal pain, asthmatic crisis, cellulitis, idiopathic thrombocytopenic purpura, lymphadenopathy, acute disseminated encephalomyelitis, Guillain-Barré syndrome, and upper respiratory tract infection), syncope sometimes accompanied by tonic-clonic movements, and hypersensitivity reactions (including anaphylactic reactions, bronchospasm, and urticaria). DOSAGE AND ADMINISTRATION: A three dose schedule is recommended: 0, 2, and 6 months. In children aged 9–14 years, a 2 dose schedule can be given, with the second dose 5–13 months after the first. Administer entire contents of the syringe intramuscularly in the deltoid region of the upper arm or in the higher anterolateral area of the thigh. Store at 2–8°C; do not freeze; protect from light. Before prescribing, please review the Data Sheet (10 January 2024), available from www.medsafe.govt.nz, or Seqirus (NZ) Ltd. Merck Sharp & Dohme (New Zealand) Limited, Auckland is the Sponsor of GARDASIL® 9. Copyright © 2024 Merck & Co., Inc., Rahway, NJ, USA, and its affiliates. All rights reserved
  

VIMPAT^® (lacosamide) film coated tablets (50 mg, 100 mg, 150 mg and 200 mg), oral solution (10 mg/mL) and injection (10 mg/mL) are Prescription Medicines. INDICATIONS: Monotherapy in the treatment of partial seizures with or without secondary generalisation in patients with epilepsy aged 16 years and older. Add-on therapy in the treatment of partial seizures with or without secondary generalisation in patients with epilepsy aged 4 years and older. Add-on therapy in the treatment of primary generalised tonic-clonic seizures in patients with idiopathic generalised epilepsy aged 4 years and older. CONTRAINDICATIONS: Hypersensitivity to the active substance or excipients, known second-degree or higher atrioventricular (AV) block. PRECAUTIONS: oral solution contains aspartame, may be harmful for people with phenylketonuria. Monitor for: dizziness, suicidal ideation or behaviour, depression, prolongations in PR interval, or atrial fibrillation and flutter. Caution in elderly patients, patients with cardiovascular disease, proarrhythmic conditions, diabetic neuropathy, renal or hepatic impairment. Do not use if breastfeeding and during pregnancy unless benefit outweighs the potential risk (Category B3). Patients should not drive or operate machinery. May cause dizziness or blurred vision, caution when driving or operating machinery until effects are known. ADVERSE EFFECTS: Very Common, dizziness, headache, diplopia, and nausea. Common and Serious effects: depression, balance disorder, abnormal coordination, memory impairment, cognitive disorder, somnolence, tremor, nystagmus, blurred vision, vertigo, vomiting, constipation, flatulence, pruritus, disturbed gait, asthenia, fatigue, fall, skin laceration; atrioventricular block, syncope, bradycardia, atrial fibrillation, atrial flutter, ventricular tachyarrhythmia, abnormalities in liver function tests; suicidal ideation or attempt, psychotic disorder, hallucination, confusional state, euphoric mood, aggression, agitation, insomnia, hypoesthesia, paraesthesia, dysarthria, disturbance in attention, irritability, intoxication, tinnitus, dyspepsia, dry mouth, diarrhoea, fever, rash, angioedema, muscle spasms, contusion, urticaria, agranulocytosis, drug and multi organ hypersensitivity reactions (DRESS), toxic epidermal necrolysis, and Stevens-Johnson syndrome. DOSAGE AND ADMINISTRATION: Initiate at 50 mg twice daily, increasing to 100 mg twice daily after a week. Based on response and tolerability, can be increased to a maximum of 200 mg twice a day. Lacosamide treatment may be initiated with a single loading dose of 200 mg administered under medical supervision. VIMPAT^® Injection is an alternative when oral administration is temporarily not feasible; Infuse over 15 to 60 minutes, twice daily. If VIMPAT^® has to be discontinued, this should be done gradually. Before prescribing review the VIMPAT^® Data Sheet (July 2022) available from www.medsafe.govt.nz or Seqirus (NZ) Ltd Auckland, at www.seqirus.co.nz. VIMPAT^® tablets and injection are funded medicines. Funding and Special Authority criteria apply. VIMPAT^® oral solution is a non-funded medicine. VIMPAT^® is a registered trademark of UCB Pharma. 04/24

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NZ-CRP-23-0001. TAPS DA2414ER. INSIGHT 12425. Updated January 2025.