From the Guidelines
The recommended dosing regimen for intravenous iron sucrose in patients with iron deficiency is 200 mg administered 1-3 times weekly until the desired total dose is reached, with a maximum single dose of 200 mg and a maximum weekly dose of 500 mg, as per the most recent guidelines 1.
Key Considerations
- The total dose calculation is based on body weight and hemoglobin level: Total iron deficit (mg) = [Body weight (kg) × (Target Hgb - Actual Hgb) (g/dL) × 2.4] + 500 mg for iron stores.
- Each infusion should be administered slowly over 2-5 minutes for direct IV push, or diluted in 100 mL normal saline and infused over 15-60 minutes.
- Patients should be monitored for at least 30 minutes after administration to watch for hypersensitivity reactions.
Administration and Monitoring
- The maximum single dose is typically 200 mg per session, with a maximum weekly dose of 500 mg, as recommended by the European Medicines Agency (EMA) and the Food and Drug Administration (FDA) 1.
- Treatment success should be evaluated by measuring hemoglobin levels and iron parameters (ferritin, transferrin saturation) after 4-8 weeks.
- Iron sucrose has a favorable safety profile compared to older iron formulations, with lower risk of anaphylactic reactions, though patients should still be monitored for hypotension, flushing, and other adverse effects during administration.
Recent Guidelines
- The most recent guidelines from the Kidney Disease: Improving Global Outcomes (KDIGO) conference recommend intravenous iron formulations that can replace iron deficits with 1 or 2 infusions, such as iron sucrose 1.
- The American Gastroenterological Association (AGA) also recommends intravenous iron formulations that can replace iron deficits with 1 or 2 infusions, as stated in their clinical practice update on management of iron deficiency anemia 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 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 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 [see How Supplied/Storage and Handling ( 16.2).]
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. Administer on 5 different occasions over a 14 day period.
The recommended dosing regimen for iron sucrose (intravenous iron) in patients with iron deficiency 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, administered on 5 different occasions over a 14 day period. 2
From the Research
Iron Sucrose Dosing Regimen
The recommended dosing regimen for iron sucrose in patients with iron deficiency varies depending on the patient's condition and the severity of the iron deficiency.
- The total dose of iron sucrose can be calculated based on the patient's iron deficit, which can be estimated using the Ganzoni formula 3.
- A study published in 2001 administered iron sucrose in 10 doses, each 100 mg IV push over 5 minutes, without a prior test dose, for a total dose of 1000 mg 4.
- Another study published in 2011 used a weekly dose of 200 mg of intravenous iron sucrose until the hemoglobin level was corrected or until the total dose of intravenous iron calculated for each patient was received 5.
- A 2015 study suggested 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, and a dose of 1500 mg may be more effective 3.
Administration and Monitoring
- Iron sucrose can be administered undiluted as an IV push over 5 minutes, without a prior test dose 4.
- The safety of iron sucrose administration can be monitored by recording blood pressure and adverse events after injection 4.
- Regular monitoring of hemoglobin, transferrin saturation, and ferritin levels can help assess the efficacy of iron sucrose therapy 4, 5.
Special Considerations
- Iron sucrose has been shown to be safe and effective in patients with dialysis-associated anemia, chronic kidney disease, inflammatory bowel disease, pregnancy, postpartum period, heavy menstrual bleeding, and cancer 4, 5, 6, 7.
- The use of iron sucrose similars has raised concerns about differences in efficacy and safety compared to the original iron sucrose 7.