What is the recommended dosing regimen for intravenous (IV) iron, specifically iron sucrose (iron sucrose) or ferric gluconate (ferric gluconate), during a hospital stay?

IV Iron Dosing During Hospital Stay

For hospitalized patients requiring IV iron supplementation, iron sucrose should be administered at 200 mg IV over 60 minutes every 2-3 weeks, or ferric gluconate at 125 mg IV over 60 minutes weekly for 8 doses, with a maximum total dose of 1000 mg for both preparations. 1

Recommended Dosing Regimens by Preparation

Iron Sucrose (Venofer)

• Standard dose: 200 mg IV over 60 minutes
• Frequency: Every 2-3 weeks
• Maximum single dose: 300 mg (higher doses not recommended)
• Administration method: IV infusion or slow IV push over 2-5 minutes
• Safety monitoring: Test dose at physician's discretion (25 mg slow IV push)

Ferric Gluconate (Ferrlecit)

• Standard dose: 125 mg IV over 60 minutes
• Frequency: Weekly for 8 doses (total 1000 mg)
• Maximum single dose: 125 mg (higher doses not recommended based on published trials)
• Administration method: IV infusion
• Safety monitoring: Test dose at physician's discretion (25 mg slow IV push)

Safety Considerations

• Test doses are strongly recommended for patients with:

  • Previous sensitivities to iron dextran or other IV iron preparations
  • Multiple drug allergies 1

• Adverse events to monitor for:

  • Hypotension
  • Hypertension
  • Nausea/vomiting
  • Pain/fever
  • Dyspnea
  • Pruritus
  • Headaches/dizziness 1

• Contraindication: Patients with active infection should not receive IV iron therapy 1

Target Parameters

Iron supplementation should aim to achieve:

• Hemoglobin ≥11-12 g/dL
• Serum ferritin >100 ng/mL
• Transferrin saturation (TSAT) >20% 2

Monitoring Recommendations

• Observe patients for at least 30 minutes following each infusion 2
• Monitor iron parameters to prevent iron overload
• Discontinue IV iron if TSAT >50% or serum ferritin >800 ng/mL 2
• Re-evaluate iron status 8-12 weeks after completion of therapy 2

Special Considerations

Higher Dosing Regimens

While some studies have examined higher doses of ferric gluconate (250-500 mg), these are associated with increased adverse events:

• 250 mg dose: 10% experienced side effects (nausea, vomiting, diarrhea)
• 500 mg dose: 30% experienced side effects (chills, severe nausea/vomiting, hypotension) 3

Alternative Administration Methods

For iron sucrose, a 2-minute push of 200 mg has been studied with acceptable safety profile:

• 97.5% of injections proceeded without significant adverse events
• Most common side effect was transient metallic taste (17.9%)
• Acute anaphylactoid reactions occurred in only 7 of 2,297 injections (0.3%) 4

Dosing Algorithm

1. Assess iron status: Check hemoglobin, ferritin, and TSAT
2. Select appropriate IV iron preparation:
   • Iron sucrose: Preferred for patients with higher risk of reactions
   • Ferric gluconate: Alternative option with similar efficacy
3. Determine total iron deficit based on hemoglobin and body weight
4. Administer in divided doses according to the preparation-specific regimen
5. Monitor for adverse reactions during and after administration
6. Reassess iron parameters after completion of therapy

Remember that while higher doses may be more convenient, they carry increased risk of adverse events. The standard dosing regimens provide the optimal balance of efficacy and safety for hospitalized patients.