Intravenous Iron Sucrose Administration Schedule for Iron Deficiency Anemia
The recommended intravenous (IV) administration schedule for iron sucrose in the treatment of iron deficiency anemia is 200 mg administered as an IV push over 10 minutes, with doses typically given multiple times until the calculated total iron requirement is met. 1, 2
Standard Dosing Regimens
- For most adult patients with iron deficiency anemia, iron sucrose is administered as 200 mg per dose given as an IV push over 10 minutes without dilution 1, 2
- A typical course consists of 10 doses of 100-200 mg each (total 1000-2000 mg), administered at intervals (often 1-3 times weekly) until the calculated total iron requirement is reached 2
- No test dose is required before administration of iron sucrose, unlike with iron dextran formulations 1
- Maximum single dose should not exceed 200 mg for standard administration, though higher doses have been studied in specific populations 3, 4
Special Population Considerations
- For patients with inflammatory bowel disease (IBD), single doses of up to 7 mg/kg (not exceeding 500 mg) have been studied, administered over 3.5 hours 3, 4
- For chronic kidney disease patients on hemodialysis, iron sucrose can be administered as 100-200 mg directly into the hemodialysis line 2-3 times weekly 1, 5
- For pediatric patients with chronic kidney disease, dosing is weight-based:
- <10 kg: 25 mg per dose
- 10-20 kg: 50 mg per dose
20 kg: 100 mg per dose 1
Total Iron Requirement Calculation
- Total iron needs are typically calculated based on hemoglobin level and body weight 3
- For patients with IBD with Hb 10-12 g/dL:
- <70 kg: approximately 1000 mg total iron
- ≥70 kg: approximately 1500 mg total iron 3
Monitoring and Response Assessment
- Hemoglobin levels should be monitored at baseline and periodically during treatment 3, 6
- A therapeutic response is typically defined as an increase in hemoglobin of at least 2 g/dL within 4 weeks 3
- Iron stores should be monitored via transferrin saturation (TSAT) and serum ferritin, with target values of TSAT ≥20% and ferritin ≥100 ng/mL 3
- Follow-up monitoring is recommended at 3-month intervals for the first year after normalization of hemoglobin 1
Safety Considerations
- Common side effects include arthralgia, hypotension, and injection site reactions 1, 6
- Serious adverse reactions are rare with iron sucrose compared to other IV iron formulations 1, 2
- Anaphylactic reactions are extremely rare (<1:200,000 administrations) 1, 6
- Resuscitation facilities should be available during administration despite the low risk profile 1
Efficacy Comparison with Other Iron Formulations
- IV iron sucrose shows faster response compared to oral iron therapy, with typical hemoglobin increases of 5.32 g/dL vs. 3.24 g/dL over 28 days 3, 6
- Iron sucrose has a better gastrointestinal tolerability profile than oral iron supplements 6
- Newer IV iron formulations like ferric carboxymaltose allow for higher single doses (up to 1000 mg) with shorter administration times (15 minutes) compared to iron sucrose 1, 5
Practical Administration Tips
- Iron sucrose can be administered undiluted as an IV push over 5-10 minutes for doses ≤200 mg 2
- For higher doses (in specific populations), dilution in normal saline and longer infusion times are recommended 4
- Administration should be performed by healthcare professionals trained in managing potential infusion reactions 1