What is the recommended dosing regimen for iron sucrose (iron sucrose) in a patient requiring intravenous iron supplementation?

Iron Sucrose Dosing Regimen for Intravenous Iron Supplementation

For patients requiring intravenous iron supplementation, iron sucrose should be administered at a dose of 100-200 mg per infusion, with a maximum single dose of 300 mg, given over 15-30 minutes. 1, 2

Dosing Guidelines Based on Clinical Setting

Hemodialysis Patients

• Standard dosing: 100 mg IV 1-3 times weekly 2
• Maintenance therapy: 100 mg IV weekly or every other week 2
• Maximum single dose: 300 mg (higher doses associated with increased adverse events) 3
• Administration time: 15-30 minutes for doses up to 200 mg; 30+ minutes for 300 mg doses 1, 3

Non-Dialysis Chronic Kidney Disease

• Standard dosing: 200 mg IV 1-2 times weekly 2, 4
• Total replacement dose: 1000 mg given as divided doses 2
• Administration options:
  • 200 mg as 2-minute IV push (shown safe in studies) 4
  • 200 mg over 15-30 minutes as infusion 1

Cancer-Related Anemia

• Standard dosing: 200 mg IV weekly 2
• Total course: 1000-1100 mg (typically 5-6 doses) 2
• Administration time: 60 minutes for oncology patients 2
• Hold parameters: Hold if ferritin >1000 ng/mL or TSAT >50% 2

Pediatric Patients

• Children >2 years: 50-100 μg/kg/day up to maximum 5 mg/day 2
• Maximum single dose: 100 mg in children 2

Administration Methods

IV Push (Bolus)

• 200 mg can be safely administered as a 2-minute IV push in CKD patients 4
• Benefits: Saves nursing time, reduces need for IV fluids and administration tubing 4
• Common side effect: Transient metallic taste (17.9% of injections) 4

IV Infusion

• Standard infusion: 100-200 mg diluted in 100 mL normal saline over 15-30 minutes 1
• Higher doses: 300 mg should be administered over at least 30 minutes 3
• Safety note: Doses of 400-500 mg over 2 hours have shown unacceptable rates of adverse events 3

Monitoring Parameters

• Before initiation: Hemoglobin, serum ferritin, and transferrin saturation (TSAT) 2, 5
• Target parameters: TSAT ≥20% and serum ferritin ≥100 ng/mL 2
• Response assessment: Hemoglobin increase of at least 2 g/dL within 4 weeks indicates adequate response 5
• Follow-up monitoring: Check iron status (ferritin, TSAT) 8-12 weeks after completion of therapy 5

Safety Considerations

• Contraindications: Hypersensitivity to iron sucrose, iron overload, anemia not due to iron deficiency 5, 1
• Common adverse effects: Hypotension, metallic taste, injection site reactions 4
• Serious adverse effects: Rare anaphylactoid reactions (0.3% in one large study) 4
• Caution: Avoid in patients with active infection 2, 5
• Observation: Monitor patients for at least 30 minutes after first dose 5

Clinical Pearls

• Iron sucrose has better safety profile than iron dextran (lower risk of anaphylactic reactions) 2
• No test dose is required for iron sucrose (unlike iron dextran), but is recommended for patients with multiple drug allergies 2
• Iron sucrose is not dialyzable through high-efficiency or high-flux dialysis membranes 1
• For patients requiring large iron repletion, divided doses are safer than single large doses 3
• Iron sucrose can be given as a 2-minute IV push in stable CKD patients, offering significant time and cost savings 4

Remember that while higher doses (400-500 mg) have been studied, they are associated with increased adverse events and are not recommended for routine use 3.