What is the recommended iron gluconate infusion regimen for treating iron deficiency anemia?

From the Guidelines

The recommended iron gluconate infusion regimen for treating iron deficiency anemia is 31.25 to 125 mg of iron gluconate administered every week for 8 weeks, with measurement of the TSAT and serum ferritin no sooner than 2 to 7 days after the last dose 1. This regimen is based on the guidelines for anemia of chronic kidney disease, which suggest that iron gluconate can be administered in doses of 31.25 to 125 mg per week for 8 weeks, with the goal of replenishing iron stores and improving hemoglobin levels. The frequency of maintenance IV iron therapy can be thrice weekly, twice weekly, weekly, or every other week, but should provide 250 to 1,000 mg of iron within 12 weeks 1. Some key points to consider when administering iron gluconate include:

• Doses of 100 to 125 mg require 7 days to elapse for accurate monitoring of TSAT and serum ferritin 1
• Measurement of transferrin saturation and serum ferritin may be inaccurate if they are performed within 14 days of receiving a single dose of 1 gram or more of iron intravenously 1
• Iron gluconate is generally better tolerated than iron dextran, with lower risk of anaphylaxis, though patients may still experience side effects such as hypotension, flushing, or nausea 1
• The infusion should be slowed or stopped if adverse reactions develop, and vital signs should be monitored, particularly during the first 30 minutes, as hypersensitivity reactions can occur 1. It is essential to note that the administration of IV iron should be individualized based on the patient's response to treatment and their underlying medical condition, and that the guidelines may vary depending on the specific patient population and clinical context 1.

From the Research

Iron Gluconate Infusion Regimen

The recommended iron gluconate infusion regimen for treating iron deficiency anemia is as follows:

• The total iron concentration in the serum increased rapidly in a dose-dependent manner after intravenous administration of ferric carboxymaltose 2
• Sodium ferric gluconate complex (SFGC) in sucrose can be administered as a single dose of 312,375, or 500 mg infused over 2 hours 3
• A second dose of SFGC can be administered 6 to 8 weeks later, if needed 3
• Modern iron formulations, including sodium ferric gluconate, can be infused at different doses and allow correction of total iron deficit with single or repeated doses in 1-2 weeks depending on the specific formulation 4
• Intravenous iron therapy is reserved for iron deficiency anemia patients with intolerance or unresponsiveness of oral iron 4

Key Considerations

• All iron preparations are associated with a risk of severe infusion reactions 4
• The risk of moderate to severe infusion reactions was comparable among all modern preparations, affecting <1% of patients 4
• Individual selection of the appropriate iron therapy and evaluation of treatment response are mandatory to safely deliver improved outcome through intravenous iron therapies 4
• Significant and clinically relevant differences exist between sodium ferric gluconate and other intravenous iron preparations in terms of their immunogenic potential, safety, and convenience of use 5

Administration Guidelines

• Sodium ferric gluconate can be administered as a single dose or in repeated doses 3, 4
• The infusion time for sodium ferric gluconate can range from 2 hours to 15 minutes, depending on the specific formulation and dose 3, 2
• A test dose may not be required for some intravenous iron formulations, such as iron isomaltoside 1000 (Monofer) 5