Venofer (Iron Sucrose) Infusion Protocol
Venofer must only be administered intravenously either by slow injection or by infusion, with the dosage expressed in mg of elemental iron (20 mg/mL). 1
Administration Methods
Direct IV Injection (Slow IV Push)
- Administer undiluted at a rate of 100 mg over 2-5 minutes 1
- This method is more convenient than longer infusions and is licensed for use 2
IV Infusion
- For 100 mg dose: Dilute in maximum 100 mL of 0.9% NaCl and infuse over at least 15 minutes 1
- For 200 mg dose: Dilute in maximum 100 mL of 0.9% NaCl and infuse over 15 minutes 1
- For 300-500 mg doses: Dilute in maximum 250 mL of 0.9% NaCl 1, 3
Dosing by Patient Population
Hemodialysis-Dependent CKD (HDD-CKD)
- Administer 100 mg per consecutive hemodialysis session, early during dialysis (generally within first hour) 1
- Usual total treatment course is 1000 mg 1
- Treatment may be repeated if iron deficiency recurs 1
Non-Dialysis Dependent CKD (NDD-CKD)
- Option 1: 200 mg on 5 different occasions over a 14-day period (total 1000 mg) 1
- Option 2: 500 mg on Day 1 and Day 14 (total 1000 mg), infused over 3.5-4 hours 1
Peritoneal Dialysis Dependent CKD (PDD-CKD)
- Administer in 3 divided doses within a 28-day period: 1
- Two infusions of 300 mg over 1.5 hours, 14 days apart
- One infusion of 400 mg over 2.5 hours, 14 days after second dose
Pediatric Patients (2 years and older)
- For maintenance: 0.5 mg/kg (not exceeding 100 mg per dose) 1
- For HDD-CKD: Every two weeks for 12 weeks 1
- For NDD-CKD or PDD-CKD: Every four weeks for 12 weeks 1
Safety Considerations
Maximum Dosing
- Maximum single dose: 200 mg 3
- Maximum weekly dose: 500 mg 3
- Typical administration is 100 mg per dose to minimize risk of adverse effects 4
Monitoring
- Monitor vital signs during and after infusion 2
- Follow hemoglobin, ferritin, and transferrin saturation levels to assess response to therapy 4, 5
- Free iron may occur if 100 mg is administered when transferrin levels are less than 180 mg/dL 4
Potential Adverse Effects
- Hypotension and flushing (rare) 4, 5
- Abdominal cramps (rare, particularly when co-administered with ACE inhibitors) 4, 5
- Arthralgias and myalgias (acute rather than delayed) 4, 5
- These adverse effects are dose-related and rarely occur with doses of 100 mg or less 4
Clinical Efficacy
- Iron sucrose has been shown to effectively maintain hemoglobin levels in hemodialysis patients 6, 7
- IV iron sucrose is more effective both clinically and financially than oral iron preparations in hemodialysis patients 8
- When combined with low-dose erythropoietin, iron sucrose shows rapid improvement in anemia correction in predialysis CKD patients 9
Important Precautions
- Anaphylaxis may occur with IV iron preparations, so resuscitation facilities should be available during administration 2
- Patients with active infection should not receive IV iron therapy 3
- Test doses are not required for iron sucrose (unlike iron dextran), but are recommended for patients with history of sensitivities to IV iron preparations or multiple drug allergies 3