ferumoxides

Action and Spectrum

Actions and Spectrum:  

ferumoxides is a contrast agent used in magnetic resonance imaging (MRI) to help enhance the visibility of certain tissues or organs. Its action involves the interaction with the magnetic field generated by the MRI scanner, which causes the particles to align with the field and emit a signal that can be detected by the scanner. 

The spectrum of ferumoxides refers to its ability to enhance the signal intensity in T2-weighted MRI images, which are sensitive to the presence of water molecules. ferumoxides has a strong T2 relaxation effect,

which means that it shortens the relaxation time of the water molecules in the tissues it accumulates in. This results in a darker signal on the MRI image, making those tissues more visible and distinguishable from surrounding tissues. 

Drug Interaction

Adverse Reaction

Frequency defined 

Adults 

Nausea (0.7%) 

Pain back/leg/pain leg (3.6%) 

Headache (0.8%) 

Pain chest (0.7%) 

Hypersensitivity (3.4%) 

Vasolidation (2.1%) 

Urticaria (0.7%) 

Dyspnea (0.5%) 

Black Box Warning

Black Box Warning:  

Warning: risk of anaphylaxis 

ferumoxides injection may cause anaphylaxis, a severe and potentially life-threatening allergic reaction. Anaphylaxis can occur after any dose of ferumoxides injection, even if the patient has tolerated previous doses.

Patients should be monitored for signs and symptoms of anaphylaxis during and after administration of ferumoxides injection. Emergency equipment and personnel should be immediately available during an anaphylactic reaction. 

before administration, patients should be screened for any history of allergy, asthma, or other hypersensitivity reactions. Patients with a known hypersensitivity to ferumoxides or any of its components should not receive ferumoxides injections. 

Healthcare providers should familiarize themselves with the signs and symptoms of anaphylaxis, including urticaria, angioedema, difficulty breathing, hypotension, and shock. Treatment of anaphylaxis may include epinephrine, oxygen, intravenous fluids, and other supportive measures. 

Contraindication / Caution

Contraindication/Caution:  

Hypersensitivity: ferumoxides should not be used in patients with a known hypersensitivity or allergic reaction to the drug or any of its components. 

Pregnancy: ferumoxides is classified as a pregnancy category C drug, which means that it may be harmful to an unborn baby.  

Breastfeeding: It is unknown whether ferumoxides is excreted in human milk, so caution should be exercised when administering the drug to breastfeeding women. 

Renal impairment: ferumoxides can be excreted through the kidneys, so caution should be used when administering the drug to patients with renal impairment. 

Liver disease: ferumoxides can be metabolized by the liver, so caution should be used when administering the drug to patients with liver disease. 

Hemochromatosis: ferumoxides can increase iron stores in the body, which can harm patients with hemochromatosis, a condition in which the body absorbs too much iron.  

Heart disease: ferumoxides can cause changes in heart rhythm, so caution should be used when administering the drug to patients with heart disease or a history of heart rhythm problems. 

Pregnancy / Lactation

Pregnancy warnings:     

Pregnancy category: N/A 

Lactation: Excreted into human milk is unknown 

Pregnancy Categories:         

Category A: Studies that were well-controlled and met expectations revealed no risk to the fetus in the first or second trimester. 

Category B: There were a lack of studies on pregnant women and no evidence of risk to the fetus in animal experiments.   

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.   

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category

Pharmacology

Pharmacology:  

In terms of pharmacology, ferumoxides are administered intravenously and are rapidly taken up by cells of the reticuloendothelial system (RES), particularly in the liver, spleen, and bone marrow. The SPIONs are then metabolized and broken down, with the iron is either incorporated into hemoglobin or stored as ferritin. 

Pharmacodynamics: 

The pharmacodynamics of ferumoxides involve the ability of its SPIONs to interact with magnetic fields and be taken up by cells in the body, which can result in changes in MRI signal intensity and provide diagnostic information about certain pathologies. 

MOA:  

The mechanism of action of ferumoxides is based on their magnetic properties. SPIONs are composed of iron oxide cores that are coated with a biocompatible polymer, such as dextran. When exposed to a magnetic field, ferumoxides become magnetized and produce local distortions in the magnetic field. These distortions produce changes in the relaxation times of nearby hydrogen protons, which can be detected by an MRI scanner.  

Pharmacokinetics: 

Absorption:  

ferumoxides is administered intravenously and therefore, it is 100% bioavailable. After intravenous injection, ferumoxides distributes throughout the body. 

Distribution:  

ferumoxides distributes throughout the body after intravenous injection. It has a distribution half-life of approximately 1.5 hours. It primarily accumulates in the liver, spleen, and bone marrow, and is then cleared by the reticuloendothelial system.  

Metabolism:  

ferumoxides is not metabolized by the body. It is eliminated from the body in its original form.  

Excretion and elimination: 

ferumoxides is eliminated from the body via the reticuloendothelial system. It has an elimination half-life of approximately 14 hours. It is primarily excreted in the feces, with a small amount excreted in the urine. 

Adminstartion

Administration:  

Prior to the procedure, the patient must inform the healthcare provider of any allergies, medications or underlying medical conditions. The patient is required to fast for four hours before the procedure. They may drink clear fluids such as water, tea or coffee.  

The healthcare provider will insert an intravenous (IV) catheter into a vein in the patient’s arm or hand. The ferumoxides contrast agent is then administered through the IV catheter. The dose of ferumoxides will depend on the patient’s weight and the indication for the MRI.  

After the injection, the patient may experience a metallic taste in their mouth or a warm sensation at the injection site. These are common side effects and will resolve within a few minutes.  

The patient will then be placed in the MRI scanner and the imaging will begin. The entire procedure usually takes between 30 and 60 minutes. The healthcare provider will monitor the patient for any adverse reactions to the contrast agent, such as an allergic reaction or kidney damage. 

It is important to note that ferumoxides is contraindicated in patients with a known hypersensitivity to the contrast agent or any of its components. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: ferumoxides 

Why do we use ferumoxides?  

ferumoxides is a type of superparamagnetic iron oxide (SPIO) nanoparticle that has been used in medical imaging applications, particularly in magnetic resonance imaging (MRI). ferumoxides are used as a contrast agent in MRI to enhance the visibility of certain tissues, such as liver and spleen, by making them appear brighter on the images. 

ferumoxides are taken up by cells in the liver and spleen, where they are processed and excreted, resulting in a contrast effect in the MRI images. ferumoxides have also been used in other applications, such as in targeted drug delivery, where they can be used to deliver drugs to specific cells or tissues in the body. 

Overall, the use of ferumoxides in medical imaging and other applications is based on their unique properties as SPIO nanoparticles, which allow for targeted contrast enhancement and drug delivery.