What is the appropriate dosing for intravenous (IV) Venofer (Iron Sucrose) administration?

From the Guidelines

The recommended dosing for intravenous (IV) Venofer (Iron Sucrose) administration is 200 mg with a maximum single dose of 200 mg and a maximum weekly dose of 500 mg, with a minimum infusion time of 30 minutes for the maximum dose, as per the most recent guidelines from the Kidney Disease: Improving Global Outcomes (KDIGO) conference 1. The dosing regimen for IV iron sucrose should be individualized based on the patient's hemoglobin level, body weight, and total iron deficit.

• The maximum single dose of 200 mg should not be exceeded, and the minimum infusion time for the maximum dose should be at least 30 minutes, as recommended by the European Medicines Agency (EMA) 1.
• The maximum weekly dose of 500 mg should also be adhered to, to minimize the risk of adverse reactions.
• Before administering IV iron sucrose, a test dose of 25 mg over 1-2 minutes should be performed to check for anaphylactic reactions, and patients should be monitored for signs of hypotension, nausea, or anaphylaxis during and after infusion. The choice of IV iron sucrose over other formulations is due to its lower risk of anaphylactic reactions and ability to deliver a higher dose in a shorter time, making it a preferred option for patients with iron deficiency anemia, particularly those with chronic kidney disease (CKD) 1.
• IV iron sucrose replenishes iron stores more rapidly than oral iron and is better tolerated in patients with gastrointestinal issues or poor oral iron absorption.
• The use of IV iron sucrose should be guided by the most recent clinical guidelines and evidence-based recommendations, such as those from the KDIGO conference 1.

From the FDA Drug Label

2 DOSAGE & ADMINISTRATION Venofer must only be administered intravenously either by slow injection or by infusion. The dosage of Venofer is expressed in mg of elemental iron. Each mL contains 20 mg of elemental iron.

1. 1 Mode of Administration Administer Venofer only intravenously by slow injection or by infusion. The dosage of Venofer is expressed in mg of elemental iron. Each mL contains 20 mg of elemental iron.

2. 2 Adult Patients with Hemodialysis Dependent-Chronic Kidney Disease (HDD-CKD) Administer Venofer 100 mg undiluted as a slow intravenous injection over 2 to 5 minutes, or as an infusion of 100 mg diluted in a maximum of 100 mL of 0.9% NaCl over a period of at least 15 minutes, per consecutive hemodialysis session

3. 3 Adult Patients with Non-Dialysis Dependent-Chronic Kidney Disease (NDD-CKD) Administer Venofer 200 mg undiluted as a slow intravenous injection over 2 to 5 minutes or as an infusion of 200 mg in a maximum of 100 mL of 0. 9% NaCl over a period of 15 minutes.

4. 4 Adult Patients with Peritoneal Dialysis Dependent-Chronic Kidney Disease (PDD-CKD) Administer Venofer in 3 divided doses, given by slow intravenous infusion, within a 28 day period: 2 infusions each of 300 mg over 1.5 hours 14 days apart followed by one 400 mg infusion over 2.5 hours 14 days later.

2.5 Pediatric Patients (2 Years of Age and Older) with HDD-CKD for Iron Maintenance Treatment For iron maintenance treatment: Administer Venofer at a dose of 0.5 mg/kg, not to exceed 100 mg per dose, every two weeks for 12 weeks given undiluted by slow intravenous injection over 5 minutes or diluted in 0. 9% NaCl at a concentration of 1 to 2 mg/mL and administered over 5 to 60 minutes.

The appropriate dosing for intravenous (IV) Venofer (Iron Sucrose) administration is as follows:

• Adult Patients with Hemodialysis Dependent-Chronic Kidney Disease (HDD-CKD): 100 mg undiluted as a slow intravenous injection over 2 to 5 minutes, or as an infusion of 100 mg diluted in a maximum of 100 mL of 0.9% NaCl over a period of at least 15 minutes, per consecutive hemodialysis session.
• Adult Patients with Non-Dialysis Dependent-Chronic Kidney Disease (NDD-CKD): 200 mg undiluted as a slow intravenous injection over 2 to 5 minutes or as an infusion of 200 mg in a maximum of 100 mL of 0.9% NaCl over a period of 15 minutes.
• Adult Patients with Peritoneal Dialysis Dependent-Chronic Kidney Disease (PDD-CKD): 3 divided doses, given by slow intravenous infusion, within a 28 day period: 2 infusions each of 300 mg over 1.5 hours 14 days apart followed by one 400 mg infusion over 2.5 hours 14 days later.
• Pediatric Patients (2 Years of Age and Older) with HDD-CKD for Iron Maintenance Treatment: 0.5 mg/kg, not to exceed 100 mg per dose, every two weeks for 12 weeks given undiluted by slow intravenous injection over 5 minutes or diluted in 0.9% NaCl at a concentration of 1 to 2 mg/mL and administered over 5 to 60 minutes 2.

From the Research

Intravenous Venofer (Iron Sucrose) Administration

• The appropriate dosing for intravenous (IV) Venofer (Iron Sucrose) administration is not explicitly stated in the provided studies, but a study comparing the efficacy of 1000 mg iron sucrose to 1500 mg ferric carboxymaltose suggests that a total cumulative dose of 1000 mg of IV iron may be insufficient for iron repletion in a majority of patients with iron deficiency anemia (IDA) 3.
• Another study mentions that iron sucrose can be administered at a dose of up to 1000 mg, but does not provide specific guidance on the dosing regimen 4.
• A study on ferric carboxymaltose mentions that it can be administered in doses of up to 1000 mg, and that the full dose is two administrations of up to 750 mg separated by at least 7 days (up to 1500 mg total), but this is not directly applicable to iron sucrose 5.
• Other studies discuss the use of high-dose intravenous iron repletion, but do not provide specific guidance on the dosing regimen for iron sucrose 6, 7.

Dosing Considerations

• The dosing of IV iron should be individualized based on the patient's iron deficit, which can be calculated using a modified Ganzoni formula 3.
• The choice of IV iron formulation and dosing regimen should be based on the patient's specific needs and medical history, as well as the potential risks and benefits of each formulation 4, 7, 5.