How to Order Venofer (Iron Sucrose)
Order Venofer as 100-200 mg IV push over 2-5 minutes or as an infusion over 15 minutes, with dosing frequency and total dose determined by the patient's CKD status and iron deficiency severity. 1
Dosing by Patient Population
Hemodialysis-Dependent CKD (HDD-CKD)
- Dose: 100 mg IV per dialysis session
- Administration: Undiluted slow IV push over 2-5 minutes OR diluted in maximum 100 mL 0.9% NaCl over 15 minutes
- Timing: Give early in dialysis session (within first hour)
- Total course: 1000 mg (typically 10 doses)
- Frequency: Each consecutive hemodialysis session 1
This regimen is supported by the KDIGO guidelines showing maximum single dose of 200 mg with maximum weekly dose of 500 mg 2. The FDA label specifically approves the 100 mg dose for hemodialysis patients 1.
Non-Dialysis Dependent CKD (NDD-CKD)
- Dose: 200 mg IV per administration
- Administration: Undiluted slow IV push over 2-5 minutes OR diluted in maximum 100 mL 0.9% NaCl over 15 minutes
- Frequency: 5 doses over 14 days (total 1000 mg)
- Alternative regimen (limited experience): 500 mg diluted in maximum 250 mL 0.9% NaCl over 3.5-4 hours on Day 1 and Day 14 1
Research demonstrates that IV iron sucrose 1000 mg in divided doses is superior to oral iron therapy in NDD-CKD patients 3.
Peritoneal Dialysis-Dependent CKD (PDD-CKD)
- Dose: 3 divided doses over 28 days:
- 300 mg over 1.5 hours (Day 1)
- 300 mg over 1.5 hours (Day 15)
- 400 mg over 2.5 hours (Day 29)
- Dilution: Maximum 250 mL 0.9% NaCl 1
This regimen has been validated in randomized controlled trials showing safety and efficacy 4.
Pediatric Patients (≥2 years)
HDD-CKD:
- Dose: 0.5 mg/kg (max 100 mg) every 2 weeks for 12 weeks
- Administration: Undiluted over 5 minutes OR diluted in 0.9% NaCl (1-2 mg/mL concentration) over 5-60 minutes
NDD-CKD or PDD-CKD on erythropoietin:
- Dose: 0.5 mg/kg (max 100 mg) every 4 weeks for 12 weeks
- Administration: Same as above 1
Critical Safety Considerations
Maximum Safe Doses
Do not exceed 200 mg as a rapid push or 300 mg as an infusion. Research demonstrates that 500 mg doses over 2 hours resulted in adverse reactions (dizziness, hypotension, nausea) in 36% of patients, while 400 mg doses caused reactions in 6% 5. The 200-300 mg doses over 2 hours showed no adverse events in large prospective studies 5, 6.
Monitoring Requirements
- Observe patient for at least 30 minutes post-administration for hypersensitivity reactions 1
- Have resuscitation equipment immediately available 1
- Do not measure serum iron or TSAT for at least 48 hours after dosing (falsely elevated) 1
- Monitor hemoglobin, hematocrit, ferritin, and TSAT periodically 1
Contraindications and Warnings
- Absolute contraindication: Known hypersensitivity to Venofer 1
- Do not administer if evidence of iron overload exists 1
- Serious hypersensitivity reactions including anaphylaxis can occur—most within 30 minutes of completion 1
- Hypotension may occur, related to rate and total dose 1
Practical Administration Tips
The 2-minute push administration has been extensively studied: in a prospective evaluation of 2,297 injections of 200 mg over 2 minutes, only 2.5% had adverse events (excluding transient metallic taste in 17.9%), with considerable time and cost savings 7. This rapid administration is safe and practical for the 100-200 mg doses 7.
For doses >200 mg, use infusion method over longer periods to minimize adverse reactions 5.
Comparison to Other IV Iron Formulations
While newer formulations like ferric carboxymaltose and ferric derisomaltose allow single 1000 mg infusions 2, 8, 9, Venofer requires divided dosing but has an extensive safety profile with decades of use. The KDIGO guidelines list Venofer with a concentration of 20 mg/mL elemental iron, maximum single dose 200 mg, and maximum weekly dose 500 mg 2.
When to Repeat Treatment
Repeat Venofer treatment when iron deficiency recurs, as evidenced by declining hemoglobin, ferritin <100 ng/mL (in inflammatory states) or <30 ng/mL (non-inflammatory), or TSAT <20% 10, 8, 1.