What is the protocol for inpatient intravenous (IV) iron replacement therapy?

From the Guidelines

Inpatient intravenous (IV) iron replacement therapy should utilize ferric carboxymaltose, with a maximum recommended cumulative dose of 1000 mg iron (20 mL FCM)/week, administered as an undiluted slow bolus injection or infusion, with patients observed for adverse effects for at least 30 min following each IV injection. When determining the initial iron need, it is calculated based on body weight and Hb levels, rather than ferritin or TSAT levels 1. The administration of IV ferric carboxymaltose can be done in two ways:

• As an injection: given as an undiluted slow bolus injection (100 mg/min, or 15 min for a 1000 mg dose)
• As an infusion: FCM should not be over-diluted as this affects the stability of the drug Key considerations for IV iron replacement therapy include:
• Monitoring patients for adverse effects for at least 30 min following each IV injection
• Re-evaluating iron status at 3 months after IV administration of the correction dose 1
• Ensuring the determination of the initial iron need is calculated based on body weight and Hb levels It is essential to prioritize the patient's safety and monitor for potential infusion reactions, including hypotension, flushing, and back pain. By using ferric carboxymaltose for inpatient IV iron replacement therapy, healthcare providers can effectively replenish iron stores and improve hemoglobin levels in hospitalized patients, ultimately reducing morbidity, mortality, and improving quality of life 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. Administer Venofer only intravenously by slow injection or by infusion.

For adult patients, the protocol varies based on the type of chronic kidney disease (CKD):

• Hemodialysis Dependent-CKD (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.
• Non-Dialysis Dependent-CKD (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.
• Peritoneal Dialysis Dependent-CKD (PDD-CKD): 3 divided doses, given by slow intravenous infusion, within a 28 day period.

The protocol for inpatient intravenous (IV) iron replacement therapy using Venofer (iron sucrose) is to administer the drug intravenously either by slow injection or by infusion, with the dosage expressed in mg of elemental iron. The specific administration protocol varies based on the type of chronic kidney disease (CKD) and the patient's weight. For adult patients, the recommended dosages are:

• 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.
• 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.
• PDD-CKD: 3 divided doses, given by slow intravenous infusion, within a 28 day period. For ferric carboxymaltose (Injectafer), the recommended dosage is:
• For patients weighing 50 kg or more: 750 mg intravenously in two doses separated by at least 7 days for a total cumulative dose of 1,500 mg of iron per course.
• For patients weighing less than 50 kg: 15 mg/kg body weight intravenously in two doses separated by at least 7 days per course. 2 3

From the Research

Protocol for Inpatient Intravenous (IV) Iron Replacement Therapy

The protocol for inpatient intravenous (IV) iron replacement therapy involves the administration of IV iron formulations, such as ferric carboxymaltose, to replenish iron stores and improve hemoglobin levels in patients with iron-deficiency anemia. The key aspects of this protocol are:

• Dosing: The dose of IV iron can range from 1000 mg to 1500 mg, depending on the patient's iron deficit and medical condition 4.
• Administration: IV iron can be administered over a short period, typically 15 minutes or less, without the need for test dosing 5, 6.
• Formulations: Different IV iron formulations are available, including ferric carboxymaltose, iron sucrose, and ferumoxytol, each with its own safety profile and dosing regimen 7, 8.
• Monitoring: Patients receiving IV iron therapy should be monitored for adverse events, such as infusion-related reactions, hypophosphatemia, and skin staining 7.

Key Considerations

Some key considerations for inpatient IV iron replacement therapy include:

• Iron deficit calculation: The iron deficit should be calculated using a modified Ganzoni formula to determine the appropriate dose of IV iron 4.
• Patient selection: IV iron therapy is recommended for patients with severe iron deficiency, especially in the presence of anemia, intolerance or inefficacy following oral iron, or states of inflammation where upregulation of hepcidin may impair gastrointestinal absorption of iron 7.
• Safety profile: IV iron formulations have an excellent overall safety profile, but potential adverse effects should be recognized and managed promptly 7, 8.

Clinical Evidence

Clinical studies have demonstrated the efficacy and safety of IV iron therapy in patients with iron-deficiency anemia, including those with chronic kidney disease 5, 6, 8. The choice of IV iron formulation and dosing regimen should be based on individual patient needs and medical conditions.