How many doses of Venofer (iron sucrose) 200 mg should be administered for iron replacement?

Venofer Dosing for Iron Replacement

For iron replacement therapy, Venofer (iron sucrose) 200 mg is typically administered as 5 doses given over 2 weeks, for a total of 1000 mg elemental iron. 1

Standard Dosing Regimens

The FDA-approved dosing varies by clinical context:

Non-Dialysis Dependent CKD (NDD-CKD)

• 200 mg administered 5 times within 14 days (total 1000 mg) 1
• Alternative: Two 500 mg infusions on Day 1 and Day 14 1
• The 200 mg dose is given over 2-5 minutes as IV push 1

Hemodialysis Dependent CKD (HDD-CKD)

• 100 mg doses at 10 consecutive dialysis sessions (total 1000 mg) 1
• Can be given as slow injection (2-5 minutes) or infusion (10-30 minutes) 2, 3

Peritoneal Dialysis Dependent CKD (PDD-CKD)

• 300 mg on Day 1 and 15, then 400 mg on Day 29 1

General Iron Deficiency Anemia (Non-CKD)

The most practical approach is 200 mg doses given weekly until iron deficit is corrected 4. The 2024 AGA guidelines indicate the typical schedule is "200 mg × 5 or 300 mg × 3 weekly" 4, meaning either:

• Five 200 mg doses (1000 mg total), or
• Three 300 mg doses (900 mg total)

Key Administration Details

Maximum single dose: 200 mg 2, 3

• Can be given over 10 minutes (EMA) or 2-5 minutes (FDA) 3
• Maximum weekly dose: 500 mg 3

Important Caveats

1. Avoid doses >200 mg in small patients: Serious hypotension occurred in women <65 kg receiving 500 mg doses 5. The 200 mg dose over 2-5 minutes has an excellent safety profile.

2. Calculate total iron deficit first: The number of doses depends on the patient's calculated iron deficit, which varies based on body weight and hemoglobin level 1.

3. Newer formulations are preferred when available: The 2024 AGA guidelines note that "formulations that can replace iron deficits with 1 to 2 infusions are preferred" 4 due to convenience, though Venofer remains effective and is the most cost-effective option at $441.50 for a typical course 4.

4. Monitor response: Hemoglobin should increase by 1 g/dL within 2 weeks; if not, consider switching to a different IV iron formulation 4.

5. Resuscitation facilities required: All IV iron formulations carry risk of anaphylaxis, though true allergy is rare—most reactions are complement activation-related pseudo-allergy 4.

The practical answer for most clinical scenarios: 5 doses of 200 mg given over 2 weeks provides 1000 mg total elemental iron, which is sufficient for most patients with iron deficiency anemia 1, 5.