What is the initial dose of iron sucrose (iron sucrose) for the treatment of iron deficiency anemia?

Initial Dosing of Iron Sucrose for Iron Deficiency Anemia

The initial dose of iron sucrose for the treatment of iron deficiency anemia is 100-300 mg per week for a total dose of 1-1.2 g during the induction phase, with repeated dosing limited to 200-300 mg per treatment episode. 1

Dosing Guidelines Based on Clinical Context

Standard Dosing for Iron Deficiency Anemia:

• Iron sucrose is typically administered as 100-300 mg weekly during the induction phase for a total dose of 1-1.2 g, which may be repeated up to a total of 2-2.4 g 1
• Single doses of up to 7 mg/kg iron sucrose have been tested, but repeated dosing is generally limited to 200-300 mg per treatment episode 1
• A test dose is not required for iron sucrose, unlike iron dextran preparations which carry a risk for serious anaphylactic reactions 1

Dosing Based on Patient Weight and Hemoglobin Levels:

• For patients with hemoglobin 10-12 g/dL (women) or 10-13 g/dL (men):
  • <70 kg body weight: 1000 mg total dose
  • ≥70 kg body weight: 1500 mg total dose 1
• For patients with hemoglobin 7-10 g/dL:
  • <70 kg body weight: 1500 mg total dose
  • ≥70 kg body weight: 2000 mg total dose 1

Administration Guidelines

• Iron sucrose should be administered as a slow intravenous infusion 1
• The maximum individual dose is typically 200 mg per infusion 1
• For maintenance therapy in dialysis patients, the French label for iron sucrose recommends 2 mg/kg once or twice per month 1

Efficacy and Safety Considerations

• Iron sucrose is effective in raising hemoglobin levels, with studies showing mean increases of 3.29 g/dL for women and 4.58 g/dL for men 2
• Response rates are high, with 94% of male and 84% of female patients achieving at least a 2 g/dL increase in hemoglobin 2
• Iron sucrose is generally well-tolerated with minimal side effects, making it suitable for patients who cannot tolerate oral iron therapy 2, 3
• Common side effects include nausea (2.9% of patients) and injection site disorders 3, 4

Special Populations

Dialysis Patients:

• For hemodialysis patients, iron sucrose is typically administered at 100-300 mg/week for a total dose of 1-1.2 g 1
• Maintenance dosing for dialysis patients is recommended at 2 mg/kg once or twice per month 1

Pediatric Patients:

• While not approved for use in children in Europe, iron sucrose has been used in pediatric patients at doses of 100-200 mg (median 200 mg) 1, 4
• In the USA, iron sucrose is approved for use in children from 2 years of age 1

Monitoring Recommendations

• Monitor hemoglobin levels to assess response, with an expected increase of at least 2 g/dL within 4 weeks of treatment 1
• The goal of iron supplementation is to normalize both hemoglobin levels and iron stores 1
• Avoid iron overload by maintaining transferrin saturation below 50% and serum ferritin below 800 μg/L 1

Clinical Pearls and Pitfalls

• Intravenous iron should be considered as first-line treatment in patients with clinically active inflammatory bowel disease, previous intolerance to oral iron, hemoglobin below 10 g/dL, or in patients who need erythropoiesis-stimulating agents 1
• Oral iron may be used in patients with mild anemia whose disease is clinically inactive and who have not previously been intolerant to oral iron 1
• Avoid evaluating iron parameters within the first 4 weeks after administration as circulating iron can interfere with assay results 5
• The risk of iron overload in patients who are chronically bleeding (such as in inflammatory bowel disease) is intrinsically low 1