How frequently should IV Iron sucrose (iron sucrose) 200 mg be repeated in a patient with iron deficiency anemia?

Frequency of IV Iron Sucrose Administration for Iron Deficiency Anemia

For patients with iron deficiency anemia, IV iron sucrose 200 mg should be administered once weekly until the calculated total iron requirement is met. 1

Standard Dosing Regimen

• The recommended administration schedule for iron sucrose is 200 mg given as an IV push over 2-5 minutes or as an infusion over 15-60 minutes, with doses typically given once weekly until the calculated total iron requirement is met 1, 2
• For most adult patients with iron deficiency anemia, a typical course involves weekly administration of 200 mg doses 1, 3
• No test dose is required before administration of iron sucrose, unlike with iron dextran formulations 1, 2

Population-Specific Considerations

• For patients with chronic kidney disease (CKD):

  • Hemodialysis-dependent patients: 100 mg per dialysis session, typically 3 times weekly 2, 4
  • Non-dialysis dependent CKD: 200 mg given 5 times over a 14-day period (total 1000 mg) 2
  • Peritoneal dialysis: 300 mg on day 1,300 mg on day 14, and 400 mg on day 28 2

• For patients with inflammatory bowel disease (IBD), some protocols use higher single doses of up to 7 mg/kg (not exceeding 500 mg) administered over 3.5 hours 5

Monitoring and Response Assessment

• Hemoglobin levels should be monitored at baseline and periodically during treatment 1
• A therapeutic response is typically defined as an increase in hemoglobin of at least 2 g/dL within 4 weeks 3, 6
• Iron parameters (serum ferritin, transferrin saturation) should be checked:
  • At least once every 3 months in patients receiving intravenous iron 4
  • If individual doses of 200 mg are given, an interval of at least 7 days should occur before accurate assessment of iron parameters 4

Efficacy Considerations

• Most patients (84-94%) respond to weekly iron sucrose therapy with hemoglobin increases of at least 2 g/dL 3
• IV iron sucrose shows faster response in correcting iron stores compared to oral iron therapy 7, 8
• Patients with baseline ferritin <100 ng/mL may show greater hemoglobin response to IV iron compared to oral iron 8

Safety Considerations

• Iron sucrose is generally well tolerated with a low incidence of serious adverse reactions 3, 6
• Common side effects include arthralgia, hypotension, and injection site reactions 1
• Anaphylactic reactions are extremely rare (<1:200,000 administrations) 1
• Patients with active infection should not receive IV iron therapy 4

Practical Administration Tips

• Administration should be performed by healthcare professionals trained in managing potential infusion reactions 1
• Resuscitation facilities should be available during administration despite the low risk profile 1
• Serum ferritin levels should be monitored and preferably should not exceed 500 μg/L to avoid toxicity of iron overload 4

By following this weekly administration schedule of 200 mg iron sucrose until the calculated iron requirement is met, most patients will achieve correction of their iron deficiency anemia with minimal adverse effects.