What is the recommended Venofer (iron sucrose) dosing regimen for a patient with iron deficiency anemia, normal kidney function, severe anemia, and severe iron deficiency?

Venofer (Iron Sucrose) Dosing for Iron Deficiency Anemia Without CKD

For a patient with iron deficiency anemia (Hgb 8.7 g/dL, ferritin 5.0 ng/mL) and normal kidney function, the recommended Venofer dosing regimen is 200 mg IV administered on 5 different occasions over a 14-day period, for a total dose of 1000 mg. 1

Dosing Protocol

The FDA-approved dosing regimen for non-dialysis dependent patients includes two administration options:

1. Preferred method:

   • 200 mg undiluted as slow IV injection over 2-5 minutes OR
   • 200 mg in maximum 100 mL of 0.9% NaCl over 15 minutes
   • Administer on 5 different occasions over a 14-day period
   • Total dose: 1000 mg 1

2. Alternative method (limited experience):

   • 500 mg diluted in maximum 250 mL of 0.9% NaCl
   • Administered over 3.5-4 hours on Day 1 and Day 14
   • Total dose: 1000 mg 1

Clinical Rationale

This patient has clear indications for IV iron therapy:

• Severe anemia (Hgb 8.7 g/dL)
• Severe iron deficiency (ferritin 5.0 ng/mL, well below the 30 ng/mL threshold) 2
• The combination of these factors warrants rapid iron repletion

Expected Outcomes

Clinical studies demonstrate that IV iron sucrose effectively treats iron deficiency anemia with:

• Mean hemoglobin increase of 3.29 g/dL for women and 4.58 g/dL for men 3
• Response rates (Hgb increase ≥2 g/dL) of 84% for women and 94% for men 3
• Significant increases in serum ferritin from baseline (7.63 ng/mL to 99.0 ng/mL) 3

Monitoring Parameters

Monitor the following parameters:

• Hemoglobin and ferritin levels 2-4 weeks after completion of therapy
• Target hemoglobin increase of at least 2 g/dL 3
• Target ferritin >100 ng/mL and transferrin saturation >20% 2

Safety Considerations

• No test dose is required for iron sucrose 4
• Iron sucrose has a favorable safety profile even in patients with previous iron dextran sensitivity 4
• Common side effects are generally mild and may include:
  • Hypotension
  • Nausea
  • Vomiting
  • Headache
  • Dizziness

Important Caveats

• Ensure IV access is secure before administration
• Have emergency medications available (although serious reactions are rare)
• Avoid administration with oral iron (discontinue oral iron before starting IV therapy)
• Investigate underlying cause of iron deficiency while treating with iron replacement

Treatment Alternatives

If iron sucrose is unavailable, other IV iron formulations like iron isomaltoside (ferric derisomaltose) may be considered, which allows for higher single doses (1000 mg infusion over >15 minutes) 5. However, iron sucrose has a well-established safety profile with over 70 years of clinical experience 6.