Which IV iron formulation has the highest incidence of adverse events?

The formulation associated with the highest incidence of adverse events is iron dextran. This particular IV iron preparation is known for its potential to cause serious allergic reactions, including anaphylaxis, which is a life-threatening condition. The risk of adverse events with iron dextran is notably higher compared to other formulations because it is more likely to provoke an immune response, particularly in individuals who have never been exposed to iron products previously.

Iron dextran requires a test dose before administration to assess for allergic reactions, underscoring the potential for serious adverse effects. Other formulations such as iron sucrose, iron gluconate, and ferric carboxymaltose generally have a better safety profile and are less associated with severe adverse reactions, making them preferable options in clinical practice when treating iron deficiency, especially in populations at risk of heart failure.

Understanding the safety profiles of different iron formulations is essential for optimizing patient care, particularly for those with complex conditions like heart failure, where iron supplementation can be a critical component of management.