What volume of normal saline is recommended to dilute 500mg of iron sucrose?

Iron Sucrose Administration: Dilution in Normal Saline

For 500mg of iron sucrose, dilute in a maximum of 250mL of 0.9% sodium chloride and administer over at least 15-30 minutes. 1

Proper Administration Protocol

Dilution Requirements

• Iron sucrose 500mg should be administered as follows:
  • Dilute in a maximum of 250mL of 0.9% sodium chloride (normal saline) 2, 1
  • Do not exceed this volume of diluent as it may increase the risk of adverse reactions
  • Do not dilute to concentrations below 1 mg/mL 3

Administration Rate and Timing

• The 500mg dose should be administered by slow intravenous infusion over at least 15-30 minutes 1
• For non-dialysis dependent chronic kidney disease patients, the FDA label indicates that 500mg can be diluted in a maximum of 250mL of 0.9% NaCl and administered over 3.5-4 hours 3
• Higher doses (500mg) administered too rapidly are associated with increased risk of adverse reactions including hypotension, nausea, and back pain 4

Important Considerations

Dosing Limitations

• No more than 500mg of iron sucrose should be administered per week 1
• The standard total treatment course is typically 1000mg 3
• For chronic kidney disease patients, consider splitting the 500mg dose into two 250mg infusions given on separate days 1

Safety Precautions

• No test dose is required for iron sucrose, unlike older iron formulations 1
• Monitor patients during and after administration for potential adverse reactions:
  • Most common mild reactions: nausea, headache, and hypotension 5, 6
  • Serious hypersensitivity reactions are rare but possible 1
• Slowing the infusion rate can help mitigate minor adverse reactions if they occur 7

Monitoring

• Check hemoglobin response 2-4 weeks after treatment 1
• Avoid checking iron parameters (ferritin, transferrin saturation) within 4 weeks of administration as circulating iron may interfere with accurate results 2

Special Populations

• For patients with chronic kidney disease on hemodialysis, consider smaller, more frequent dosing (100mg per session) 3
• For patients with inflammatory conditions or ongoing blood loss, repeated administrations may be necessary 1

Iron sucrose is generally well-tolerated compared to other IV iron preparations, with a lower incidence of serious adverse reactions 6, 8. However, careful attention to proper dilution and administration rate is essential to minimize the risk of adverse events, particularly with higher doses like 500mg.