IV Venofer (Iron Sucrose) Dosing and Administration Protocol
For the treatment of iron deficiency anemia, Venofer (iron sucrose) should be administered at 200 mg IV infused over 15 minutes or as a slow IV injection over 2-5 minutes, with dosing frequency determined by the underlying condition. 1
Dosing Recommendations by Patient Population
Adult Patients with Chronic Kidney Disease
Hemodialysis Dependent (HDD-CKD)
- Dose: 100 mg per session
- Administration: Undiluted as slow IV injection over 2-5 minutes OR diluted in maximum 100 mL of 0.9% NaCl over at least 15 minutes
- Frequency: During consecutive hemodialysis sessions
- Total course: Usually 1000 mg (10 doses)
- Timing: Early during dialysis session (generally within first hour) 1
Non-Dialysis Dependent (NDD-CKD)
- Dose: 200 mg
- Administration: Undiluted as slow IV injection over 2-5 minutes OR diluted in maximum 100 mL of 0.9% NaCl over 15 minutes
- Frequency: 5 different occasions over a 14-day period
- Alternative dosing: 500 mg diluted in maximum 250 mL of 0.9% NaCl over 3.5-4 hours on Day 1 and Day 14 1
Peritoneal Dialysis Dependent (PDD-CKD)
- Dose: 3 divided doses within a 28-day period:
- Two infusions of 300 mg over 1.5 hours, 14 days apart
- One infusion of 400 mg over 2.5 hours, 14 days after second dose
- Administration: Diluted in maximum 250 mL of 0.9% NaCl 1
Pediatric Patients (2 Years and Older)
HDD-CKD (Iron Maintenance)
- Dose: 0.5 mg/kg (not exceeding 100 mg per dose)
- Frequency: Every two weeks for 12 weeks
- Administration: Undiluted by slow IV injection over 5 minutes OR diluted in 0.9% NaCl at 1-2 mg/mL over 5-60 minutes 1
NDD-CKD or PDD-CKD on Erythropoietin (Iron Maintenance)
- Dose: 0.5 mg/kg (not exceeding 100 mg per dose)
- Frequency: Every four weeks for 12 weeks
- Administration: Same as HDD-CKD pediatric patients 1
Cancer Patients with Iron Deficiency
- Dose: 200 mg IV over 60 minutes
- Administration: Repeated dosing every 2-3 weeks or 200 mg IV over 2-5 minutes
- Maximum individual dose: 300 mg 2
Administration Guidelines
Preparation and Dilution
- Each mL of Venofer contains 20 mg of elemental iron 1
- Do not dilute to concentrations below 1 mg/mL 1
- For infusion, dilute in 0.9% NaCl according to dose:
- 100 mg: Maximum 100 mL saline
- 200 mg: Maximum 100 mL saline
- 300-500 mg: Maximum 250 mL saline 1
Administration Rate
- Slow IV injection: 2-5 minutes for doses up to 200 mg
- IV infusion: 15-60 minutes depending on dose 1
- For higher doses (300-500 mg), longer infusion times are recommended 3
Safety Considerations
Contraindications
- Known hypersensitivity to iron sucrose or any components
- Evidence of iron overload
- Anemia not attributed to iron deficiency 1
Precautions
- Hypersensitivity reactions: Monitor patients for at least 30 minutes after administration 3, 1
- Hypotension: Monitor blood pressure during and after administration 1
- Active infection: Avoid IV iron in patients with active infection 2, 3
- No test dose is required for iron sucrose, unlike iron dextran 2
Common Adverse Effects
- Diarrhea, nausea, vomiting, headache, dizziness
- Hypotension, pruritus, pain in extremity
- Injection site reactions 1, 4
Monitoring and Efficacy
- An acceptable response is an increase in hemoglobin of at least 2 g/dL within 4 weeks of treatment 3
- Monitor hemoglobin every 4 weeks until normalization 3
- Re-evaluate iron status 8-12 weeks after completion of therapy 3
- Target parameters: hemoglobin ≥11-12 g/dL, ferritin >100 ng/mL, transferrin saturation >20% 3
Clinical Advantages
- Iron sucrose has been shown to be effective and safe with minimal risk of adverse effects compared to older iron preparations like iron dextran 4, 5
- Studies demonstrate rapid improvement in hemoglobin levels with IV iron sucrose in various patient populations 5, 6
- High-dose iron sucrose (7 mg/kg, not exceeding 500 mg) infused over 3.5 hours has been shown to be safe in patients with iron deficiency anemia due to gastrointestinal blood loss 7
Important Considerations
- Venofer must ONLY be administered intravenously, never intramuscularly or subcutaneously 1
- Treatment may be repeated if iron deficiency reoccurs 1
- For patients requiring rapid iron repletion, newer IV iron formulations like ferric carboxymaltose may allow for higher single doses (up to 750-1000 mg) with shorter administration times 3, 8