CosmoPer is used in the form of intravenous drip infusions or slow intravenous or intramuscular injections. The use of CosmoPer is possible only in a hospital with the condition of availability of anti-shock therapy. Patients should be under close supervision of the doctor during the administration of the drug and immediately after it for 1 hour. The use of CosmoPer should be immediately discontinued, with any manifestation of the hypersensitivity reaction or intolerance detected during administration.
Usually the recommended dose of CosmoPer is 100-200 mg of iron (corresponding to 2 to 4 ml of the drug) 2-3 times a week, depending on the hemoglobin content.
However, if the clinical situation requires rapid replacement of iron, it is possible intravenous drip injection of a total dose of Cosmofer - up to 20 mg / kg of body weight of the patient.
Intravenous drip infusion:
The first 25 mg of iron should be poured evenly for 15 minutes, if during this time no negative reactions appear, you can enter the remaining dose at a rate of not more than 100 ml in 30 minutes. CosmoPer can be diluted only in 0.9% solution of sodium chloride or in 5% glucose solution. A dose of 100-200 mg of iron (2-4 ml) is diluted in 100 ml of the solution.
Intravenous injection:
CosmoPer can be administered intravenously slowly (0.2 ml / min) at a dose of 100-200 mg iron (2-4 ml), preferably diluted in 10-20 ml 0.9% sodium chloride solution or 5% glucose solution.
The initial dose of the drug is 25 mg of iron or 0.5 ml of the solution, which is administered intravenously slowly for 1-2 minutes. If there are no negative reactions within 15 minutes, the remaining dose of the drug can be continued.
The total dose of CosmoFer is determined from the table or calculated using formulas. Immediately before administration, the total dose of the drug is added with aseptic compliance to the required volume (usually 500 ml) of sterile sodium chloride solution or 5% glucose solution. The total amount of CosmoPer preparation (up to 20 mg / kg body weight) is administered intravenously drip for 4-6 hours.
The rate of administration can be increased to 45-60 drops per minute.With an increase in the rate of administration, the patient should be monitored for 1 hour after the injection.
Intravenous drip administration of the drug is preferred, since it reduces the risk of the incidence of arterial hypotension.
Injections through the dialyzer:
CosmoPer can be used during the procedure of hemodialysis. The drug is injected directly into the venous dialyzer circuit.
The procedure of administration is the same as for intravenous administration.
Intramuscular injection:
The total amount of CosmoFer is determined both by the dose table and by calculations. For intramuscular injections, use undiluted preparation (2.0 ml, maximal - 4.0 ml) as a series of injections: the volume of each series is usually determined by the patient's body weight.
Patients who lead a moderately active lifestyle, injections are administered daily, alternately in different buttocks. Patients who are inactive, or bedridden patients, are injected at a frequency of one or two per week.
CosmoPer should be injected deep into the muscle, to reduce the risk of subcutaneous staining. The drug should only be injected into the muscular mass of the upper outer quadrant of the buttock, and CosmoFer can not be inserted into the arm or other external area of the body.
For adults, a 20-21G needle must be used, at least 50 mm in length; For obese patients, needles 80-100 mm long are used, and for teenagers smaller and shorter needles (23Gx32 mm) are used. The patient should lie on his side, with the side for injection up, or stand, transferring the body weight to the leg, free from injection. To avoid penetration of the drug into the subcutaneous tissue, Z-shaped technique of skin bias before injection is recommended.
CosmoPer is introduced slowly and carefully. It is important to wait a few seconds before pulling out the needle so that the muscle mass adjusts to the volume of the injected drug.
It is not recommended to rub the injection site.
Calculation of dose:
A) For patients with iron deficiency anemia:
The required dose should ideally correspond to the total iron deficiency, calculated by the formula:
Body weight in kg * (required Hb g / l - valid Hb g / l) * 0.24 + mg of iron to replenish iron stores.
The factor 0.24 is obtained as follows:
a) Blood volume of 70 ml / kg of body weight ≈ 7% of body weight
b) Iron content in hemoglobin 0.34%
The factor is 0.24 = 0.0034 * 0.07 * 1000 (the transition from r to mg).
The table below shows the number of milliliters of CosmoPer, which should be used at different degrees of iron deficiency anemia.
The results in the table below are based on the achieved hemoglobin content of 150 g / l and the iron reserve of 500 mg with a body weight above 35 kg.
The total dose of CosmoFer in milliliters for iron deficiency anemia:
| Body weight (kg) | Hemoglobin content |
| 60 g / l | 75 g / l | 90 g / l | 105 g / l | 120 g / l | 135 g / l |
| 35 | 25 | 23 | 20 | 18 | 15 | 12,5 |
| 40 | 27 | 24 | 22 | 19 | 16 | 13 |
| 45 | 29 | 26 | 23 | 20 | 16,5 | 13 |
| 50 | 32 | 28 | 24 | 21 | 17 | 13,5 |
| 55 | 34 | 30 | 26 | 22 | 18 | 14 |
| 60 | 36 | 32 | 27 | 23 | 18,5 | 14,5 |
| 65 | 38 | 33 | 29 | 24 | 19,5 | 14,5 |
| 70 | 40 | 35 | 30 | 25 | 20 | 15 |
| 75 | 42 | 37 | 32 | 26 | 21 | 15,5 |
| 80 | 45 | 39 | 33 | 27 | 21,5 | 16 |
| 85 | 47 | 41 | 34 | 28 | 22 | 16 |
| 90 | 49 | 42 | 36 | 29 | 23 | 16,5 |
Note: The table and the corresponding formula are applicable for dose determination only in patients with iron deficiency anemia. The table and formula should not be used to determine the dose in those patients who require iron substitution because of blood loss.
The total requirement for iron reflects the amount of iron needed to restore the hemoglobin concentration to normal or close to normal levels, plus an additional amount for sufficient replenishment of iron in most people with moderate or excessive hemoglobin reduction. It must be remembered that iron deficiency anemia will not manifest until all the iron stores have been depleted. Therapy, therefore, should be aimed not only at the hemoglobin supplementation with iron, but also on the replenishment of the iron reserve as a whole.
If the total required dose exceeds the maximum allowable daily dose, the administration should be carried out in several steps.The therapeutic effect can be observed a few days after the application of CosmoFer and manifest as an increase in the number of reticulocytes. The level of serum ferritin is a good indicator of iron replenishment. In patients on dialysis receiving CosmoPer, this correlation may not appear.
B) For patients with blood loss:
Iron therapy in patients with blood loss should be aimed at replenishing the amount of iron equivalent to the amount of iron in lost blood. The above table and formulas are not suitable for fast iron replenishment. Quantitative estimates of blood loss and hematocrit in humans during bleeding are a convenient way of calculating the required dose of iron.
The required dose of CosmoPer to compensate for iron deficiency is calculated according to the following formulas:
- If the volume of lost blood is unknown:
taking 200 mg of iron intravenously (4 ml CosmoPer) will lead to an increase in hemoglobin equal to the effect of 1 unit of blood (= 400 ml with 150 g / l Hb, which equals 0.34% of 0.4 * 150 or 204 mg of iron).
Iron, which must be replaced (mg) = number of blood units lost * 4.
- If Hb is lowered: use the previous formula, according to which the iron stock does not need to be restored.
The amount of mg of iron that must be substituted = body weight (kg) * 0.24 * the required Hb in g / l is the actual Hb g / l).
For example: body weight = 60 kg, deficiency Hb = 10 g / l.
Iron, which must be substituted = 60 * 0.24 * 10 = 143 mg (≈ 3 milliliters of CosmoPer).