Initial Dosing of Iron Sucrose for Pediatric Patients
For pediatric patients 2 years of age and older, the recommended initial dose of iron sucrose is 0.5 mg/kg, not to exceed 100 mg per dose. 1
Dosing Guidelines Based on Clinical Scenario
Pediatric Patients with Chronic Kidney Disease (CKD)
- For children with hemodialysis-dependent CKD (HDD-CKD) requiring iron maintenance: administer 0.5 mg/kg (maximum 100 mg) every two weeks for 12 weeks 1
- For children with non-dialysis dependent CKD (NDD-CKD) or peritoneal dialysis-dependent CKD (PDD-CKD) on erythropoietin therapy: administer 0.5 mg/kg (maximum 100 mg) every four weeks for 12 weeks 1
- Iron sucrose is FDA-approved for use in children with CKD from 2 years of age 2
Administration Method
- Iron sucrose can be administered undiluted by slow intravenous injection over 5 minutes 1
- Alternatively, it can be diluted in 0.9% NaCl at a concentration of 1 to 2 mg/mL and administered over 5 to 60 minutes 1
- Do not dilute to concentrations below 1 mg/mL to maintain stability 1
Safety Considerations
Monitoring and Precautions
- Iron status (at least ferritin and hemoglobin) should be monitored regularly in patients on long-term parenteral nutrition to prevent iron deficiency and iron overload 2
- Severe adverse events with iron sucrose are rare in children, making it the preferred IV iron formulation for pediatric use 2
- No test dose is required for iron sucrose, unlike iron dextran which requires a test dose due to higher risk of allergic reactions 2
Potential Adverse Effects
- Most common adverse effects are minor and include injection site disorders and transient taste perversion 3
- In a study of 142 pediatric patients receiving IV iron sucrose, only one patient developed cough and wheezing during infusion 4
- Systemic iron toxicity with hepatocellular damage has been reported in a pediatric patient receiving an excessive dose of 16 mg/kg 2
Clinical Evidence Supporting Use
- In a randomized controlled trial of 145 children with CKD receiving erythropoiesis-stimulating agents, iron sucrose at 0.5 mg/kg was found to be noninferior to higher doses (1.0 mg/kg and 2.0 mg/kg) in maintaining hemoglobin levels >10.5 g/dL 5
- A study of 12 children with iron deficiency anemia showed that iron sucrose was effective in raising hemoglobin concentration from 7.6±2.38 g/dL to 12.4±0.64 g/dL within 31-42 days after the first infusion 3
- A retrospective review of 44 children treated with IV iron showed significant improvements in hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, and serum ferritin levels 6
Important Considerations for Route of Administration
- Iron supplementation should preferentially be given enterally rather than parenterally if tolerated 2
- Parenteral iron should be reserved for patients who cannot maintain adequate iron status using enteral supplements 2
- For patients receiving long-term parenteral nutrition who cannot maintain adequate iron status with enteral supplements, parenteral iron supplementation is recommended 2
Dosing Adjustments for Special Populations
- For children on hemodialysis, a maintenance dose of 0.3 mg/kg/dialysis has been shown to maintain adequate iron levels 7
- Higher initial doses (3 mg/kg/dialysis) may result in possible iron overload and should be avoided 7
- A dose of 1 mg/kg/dialysis appears adequate for correction of iron deficiency in children on hemodialysis 7