What is the typical regimen for treating iron deficiency anemia with IV Venofer (iron sucrose)?

IV Venofer (Iron Sucrose) Regimen for Iron Deficiency Anemia

For iron deficiency anemia, the typical IV Venofer regimen consists of 200 mg administered intravenously 5 times over a 14-day period for non-dialysis patients, while hemodialysis patients typically receive 100 mg per consecutive dialysis session until reaching a total dose of 1000 mg. 1

Dosing Regimens Based on Clinical Setting

Non-Dialysis Dependent Chronic Kidney Disease (NDD-CKD)

• 200 mg undiluted as slow IV injection over 2-5 minutes or as infusion of 200 mg in maximum 100 mL of 0.9% NaCl over 15 minutes 1
• Administered on 5 different occasions over a 14-day period (total 1000 mg) 1
• Alternative regimen: 500 mg diluted in maximum 250 mL of 0.9% NaCl over 3.5-4 hours on Day 1 and Day 14 (total 1000 mg) 1

Hemodialysis Dependent CKD (HDD-CKD)

• 100 mg undiluted as slow IV injection over 2-5 minutes or as infusion of 100 mg diluted in maximum 100 mL of 0.9% NaCl over at least 15 minutes 1
• Administered during each consecutive hemodialysis session (typically early in session, within first hour) 1
• Usual total treatment course is 1000 mg 1

Peritoneal Dialysis Dependent CKD (PDD-CKD)

• Three divided doses within a 28-day period: 1
  • Two infusions of 300 mg over 1.5 hours, 14 days apart
  • Followed by one 400 mg infusion over 2.5 hours 14 days later
  • Diluted in maximum 250 mL of 0.9% NaCl

Dosing Considerations for Other Populations

Inflammatory Bowel Disease (IBD)

• Single doses of up to 7 mg/kg iron sucrose have been tested 2
• Repeated dosing is limited to 200-300 mg per treatment episode 2
• Total iron needs based on hemoglobin and body weight: 2
  • For Hb 10-12 g/dL (women) or 10-13 g/dL (men): 1000 mg if <70 kg, 1500 mg if ≥70 kg
  • For Hb 7-10 g/dL: 1500 mg if <70 kg, 2000 mg if ≥70 kg

Pediatric Patients (2 Years and Older)

• For iron maintenance in HDD-CKD: 0.5 mg/kg (not exceeding 100 mg per dose) every two weeks for 12 weeks 1
• For iron maintenance in NDD-CKD or PDD-CKD on erythropoietin therapy: 0.5 mg/kg (not exceeding 100 mg per dose) every four weeks for 12 weeks 1

Administration Methods

• Slow IV injection: Undiluted over 2-5 minutes 1
• IV infusion: Diluted in 0.9% NaCl (concentration 1-2 mg/mL) over 15-60 minutes depending on dose 1
• Must only be administered intravenously (never intramuscularly) 1

Monitoring and Treatment Goals

• Goal: Normalize hemoglobin levels and replenish iron stores 2
• Target response: Increase in hemoglobin of at least 2 g/dL within 4 weeks 2
• Monitor transferrin saturation (TSAT) and serum ferritin 2
  • Target TSAT ≥20% and serum ferritin ≥100 ng/mL 2
• Upper safety limits: TSAT <50% and serum ferritin <800 μg/L 2

Efficacy and Safety Considerations

• IV iron shows faster response and better tolerance than oral iron, especially in patients with IBD or CKD 2, 3
• Hemoglobin typically increases more rapidly with IV iron compared to oral iron (5.32 g/dL vs. 3.24 g/dL over 28 days in one study) 3
• Common side effects include arthralgia (joint pain) and hypotension 2, 3
• No test dose is required for iron sucrose (unlike iron dextran preparations) 2
• A total cumulative dose of 1500 mg may be more appropriate than 1000 mg for complete iron repletion in many patients 4

Clinical Pearls and Pitfalls

• IV iron is preferred first-line treatment in: 2
  • Patients with clinically active IBD
  • Previous intolerance to oral iron
  • Hemoglobin below 10 g/dL
  • Patients requiring erythropoiesis-stimulating agents
• Avoid administering doses larger than recommended as this may increase risk of side effects 1
• Iron sucrose (Venofer) is available in 100 mg (5 mL) vials 2
• Treatment may be repeated if iron deficiency recurs 1
• Retreatment requirements are significantly lower with higher cumulative doses (5.6% with 1500 mg vs. 11.1% with 1000 mg) 4