Administration of Venofer (Iron Sucrose) in IV Bags
Venofer (iron sucrose) can be diluted in a 500 mL IV bag of 0.9% sodium chloride solution alone for administration. 1
Administration Options for Venofer
- Venofer must only be administered intravenously either by slow injection or by infusion 1
- For adult patients with Non-Dialysis Dependent Chronic Kidney Disease (NDD-CKD), Venofer can be administered as an infusion of 200 mg diluted in a maximum of 100 mL of 0.9% NaCl over 15 minutes 1
- For Peritoneal Dialysis Dependent-CKD patients, Venofer can be diluted in a maximum of 250 mL of 0.9% NaCl for infusion 1
- For pediatric patients (2 years and older), Venofer can be diluted in 0.9% NaCl at a concentration of 1 to 2 mg/mL and administered over 5 to 60 minutes 1
Specific Dilution Guidelines
- Each mL of Venofer contains 20 mg of elemental iron 1
- For adult patients receiving 500 mg doses, Venofer can be diluted in a maximum of 250 mL of 0.9% NaCl 1
- Do not dilute to concentrations below 1 mg/mL for pediatric patients 1
- The FDA-approved labeling does not specifically prohibit the use of 500 mL IV bags for dilution, though it specifies maximum volumes for different patient populations 1
Safety Considerations
- Venofer has a well-established safety profile with relatively few serious adverse effects compared to other intravenous iron preparations 2
- Common adverse effects include hypotension, flushing, abdominal cramps, and arthralgias/myalgias 2
- No test dose is required before administration of Venofer, unlike some other IV iron preparations 3
- Anaphylaxis may occur with IV iron preparations, so resuscitation facilities should be available during administration 4
Clinical Efficacy
- Iron sucrose is effective in rapidly increasing hemoglobin, ferritin, and transferrin saturation levels 5
- The terminal half-life of injected iron sucrose is approximately 5-6 hours 6
- In clinical trials, iron sucrose has been shown to be well-tolerated even at higher doses (250 mg/month) 7
Important Considerations for Administration
- Monitor vital signs during and after infusion 2
- Ensure proper concentration when diluting to maintain efficacy and safety 1
- For patients with chronic kidney disease, iron sucrose has been shown to be effective in improving anemia when used alone or in combination with erythropoietin 8
- The bolus intravenous dosing of iron sucrose (200 mg iron) over 10 minutes is licensed and more convenient than a 2-hour infusion 4
While specific guidelines mention maximum dilution volumes for different patient populations, the use of a 500 mL IV bag of normal saline for dilution is not contraindicated in the FDA labeling and would provide an even more dilute solution, which may be beneficial for some patients.