Does evidence support extending the duration of intravenous iron dextran (INFeD) infusion in pregnant patients?

No, there has never been evidence with any of the four formulations supporting a longer rate of infusion (above the minimum recommended) as a harbinger of either benefit or safety. LMW ID (INFeD) should be given as 1000 mg in 250 ml of normal saline over one hour. My gut tells me 45 minutes is OK but until there is data to support it, I would stick with one hour which has been used in at least four studies. Giving it over a longer period of time subjects patients to unnecessary time in a chair.

The first prospective study of IV iron in pregnancy used a one-hour infusion of INFeD (Auerbach et al., PMID 28739199). In a marvelous paper in the Green Journal (Obstetrics and Gynecology) last year, by Saad et al., PMID 37486650 in post-partum patie...

Low molecular weight iron dextran (Infed) is a terrific option for pregnant patients with iron deficiency. Data from Wong et al., PMID 26971581 support the safety and efficacy of Infed in this patient population. Although the authors used a rapid infusion (1,000 mg in 1 hour), I tend to give Infed over ~2 hours or so as per our institutional policy. We also give a test dose of 25 mg and wait 1 hour before proceeding with the rest of the infusion, though some experts question whether a discrete test dose is required or simply a slower infusion time/careful observation for the first 10-15 minutes (Van Doren and Auerbach, PMID 38066930).