Iron Sucrose Dosing for Iron Deficiency Without Anemia
For patients with iron deficiency without anemia, the recommended dosing regimen for iron sucrose is 200 mg administered intravenously once weekly until iron stores are replenished, typically for 5 doses. 1
Diagnosis and Assessment
Before initiating iron sucrose therapy, confirm iron deficiency without anemia:
- Serum ferritin <30 ng/mL in non-inflammatory conditions
- Serum ferritin <100 ng/mL in patients with inflammation
- Transferrin saturation (TSAT) <20%
- Normal hemoglobin levels (≥12 g/dL for women, ≥13 g/dL for men)
Administration Guidelines
Dosing Protocol
- Standard dose: 200 mg per infusion
- Administration frequency: Once weekly
- Administration time: Minimum 15 minutes per infusion
- Total treatment course: Typically 5 doses (1000 mg total)
Administration Method
- Administer as slow IV push over 5-15 minutes or as an infusion
- Do not exceed 200 mg per single administration to minimize adverse effects 1
- Monitor patients for at least 30 minutes after infusion for hypersensitivity reactions
Monitoring and Follow-up
- Re-evaluate iron status 8-12 weeks after completion of therapy 1
- Target parameters:
- Ferritin >100 ng/mL
- Transferrin saturation >20%
Safety Considerations
Iron sucrose is generally well-tolerated with a favorable safety profile compared to other IV iron formulations 2, 3. However, be aware of potential adverse effects:
- Common side effects: Hypotension, flushing, infusion site reactions
- Less common: Headache, dizziness, nausea
- Rare: Hypersensitivity reactions
Contraindications
- Hypersensitivity to iron sucrose or any excipients
- Known serious hypersensitivity to other parenteral iron products
- Evidence of iron overload or disturbances in iron utilization
- Active infection (use with caution)
Clinical Pearls
- IV iron is preferred over oral iron when oral therapy has failed, is not tolerated, or rapid repletion is needed 1
- Iron sucrose has a better safety profile compared to iron dextran, with fewer serious adverse events 3
- The 200 mg weekly dosing regimen balances efficacy and safety while minimizing side effects 4
- For patients who cannot attend weekly sessions, consider alternate-day dosing rather than daily dosing, as this may improve absorption and reduce side effects 5
Pitfalls to Avoid
- Administering iron sucrose too rapidly (faster than 5 minutes), which increases risk of adverse reactions
- Failing to monitor iron parameters after treatment completion
- Using IV iron in patients with evidence of iron overload
- Administering IV iron on the same day as anthracycline chemotherapy due to potential increased cardiotoxicity 1
By following these guidelines, iron sucrose can be safely and effectively administered to patients with iron deficiency without anemia, improving iron stores and preventing progression to iron deficiency anemia.