What is the recommended dosing for iron infusion in patients with iron deficiency anemia?

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Iron Infusion Dosing for Iron Deficiency Anemia

The recommended dosing for iron infusion in patients with iron deficiency anemia varies by formulation, with ferric carboxymaltose typically administered as 750 mg intravenously in two doses separated by at least 7 days for a total cumulative dose of 1,500 mg per course for patients weighing 50 kg or more. 1

Diagnosis of Iron Deficiency

Before administering iron infusions, iron deficiency should be confirmed:

  • Absolute iron deficiency: serum ferritin <30 ng/mL in non-inflammatory conditions, or <100 ng/mL in patients with inflammation or cancer 2, 3
  • Functional iron deficiency: TSAT <20% with ferritin 100-299 ng/mL 2

Dosing Recommendations by Formulation

Ferric Carboxymaltose (Injectafer)

  • For patients ≥50 kg: 750 mg IV in two doses separated by at least 7 days (total 1,500 mg) 1
  • For patients <50 kg: 15 mg/kg body weight IV in two doses separated by at least 7 days 1
  • Alternative single-dose option: 15 mg/kg up to maximum 1,000 mg as a single dose 1

Iron Sucrose (Venofer)

  • Maximum infusion dose: 200-500 mg iron 2
  • Minimum infusion time: 30-210 minutes 2

Iron Isomaltoside/Ferric Derisomaltose (Monoferric)

  • Maximum infusion dose: 20 mg/kg body weight (up to 1,000 mg iron) 2, 3
  • Minimum infusion time: 15 minutes for doses up to 1,000 mg; >30 minutes for doses exceeding 1,000 mg 2

Ferric Gluconate

  • Maximum infusion dose: 125 mg iron 2
  • Minimum infusion time: 60 minutes 2

Iron Dextran

  • Maximum infusion dose: varies by specific iron dextran type 2
  • Minimum infusion time: 240-360 minutes 2

Calculating Total Iron Deficit

Research suggests that the typical iron deficit in patients with iron deficiency anemia is approximately 1,500 mg, which supports the standard 1,500 mg dosing for ferric carboxymaltose 4. The Ganzoni formula can be used for more precise calculations:

Total iron deficit (mg) = body weight (kg) × [target Hb - actual Hb (g/dL)] × 0.24 + 500 mg 3

Administration Guidelines

  • Ferric carboxymaltose: Can be administered undiluted as a slow IV push or diluted in 0.9% sodium chloride solution for infusion 1

    • For infusion: Dilute up to 1,000 mg in no more than 250 mL of sterile 0.9% sodium chloride (minimum concentration 2 mg/mL) 1
    • Administration time: At least 15 minutes 1
    • For slow IV push: 100 mg (2 mL) per minute; for 1,000 mg dose, administer over 15 minutes 1

  • Iron sucrose: Administer over at least 30 minutes 3

  • Monitor patients for at least 30 minutes after infusion for hypersensitivity reactions 3

Contraindications and Precautions

  • Hypersensitivity to the active substance or any excipients 2
  • Known serious hypersensitivity to other parenteral iron products 2
  • Anemia not attributed to iron deficiency 2
  • Evidence of iron overload or disturbances in iron utilization 2
  • Active infection (use with caution) 2
  • Hemoglobin >15 g/dL 2, 3

Treatment Response and Follow-up

  • An acceptable response is an increase in hemoglobin of at least 2 g/dL within 4 weeks 3
  • Re-evaluate iron status 8-12 weeks after completion of therapy 3
  • Target parameters: hemoglobin ≥11-12 g/dL, ferritin >100 ng/mL, and TSAT >20% 3
  • For patients requiring maintenance therapy, consider follow-up doses at 12,24, and 36 weeks if serum ferritin <100 ng/mL or serum ferritin 100-300 ng/mL with TSAT <20% 1

Special Considerations

  • IV iron is preferred over oral iron for patients who are intolerant or not responding to oral iron therapy 3
  • Consider IV iron as first-line treatment in patients with:
    • Clinically active inflammatory disease
    • Previous intolerance to oral iron
    • Hemoglobin below 10 g/dL
    • Ongoing blood loss
    • Symptomatic iron deficiency despite normal hemoglobin 3
  • Monitor serum phosphate levels in patients requiring repeat courses, as hypophosphatemia is a potential side effect, particularly with ferric carboxymaltose (affecting 50-74% of patients) 1, 5
  • Avoid administering IV iron on the same day as anthracycline chemotherapy 3

Research indicates that a 1,500 mg cumulative dose results in significantly lower retreatment requirements compared to 1,000 mg dosing (5.6% vs 11.1% requiring retreatment between days 56-90) 4.

References

2
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Guideline

Iron Deficiency Anemia Treatment

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

5
Research

Intravenous iron supplementation therapy.

Molecular aspects of medicine, 2020

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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