What is the recommended dose and administration rate for iron infusion, specifically iron sucrose (iron sucrose) and ferric carboxymaltose (ferric carboxymaltose)?

Iron Infusion Administration: Dosing and Duration

For iron deficiency anemia treatment, ferric carboxymaltose is recommended as the optimal IV iron formulation, allowing for administration of up to 1000 mg in a single 15-minute infusion with excellent safety and efficacy. 1, 2

Iron Sucrose Administration

Dosing

• Maximum single dose of iron sucrose is 200 mg, with a maximum weekly dose of 500 mg 3
• For doses of 300-500 mg, iron sucrose should be diluted in a maximum of 250 mL of 0.9% NaCl 3
• Bolus intravenous dosing of iron sucrose (200 mg) can be administered over 10 minutes, which is more convenient than a 2-hour infusion 3, 4
• Multiple infusions are required to achieve full iron repletion, typically 4-7 visits for complete iron replenishment 2

Administration Time

• Standard iron sucrose dose (100-200 mg) can be administered over several minutes 4
• Larger doses up to 300 mg should be administered within 60 minutes 4
• Test doses are not required for iron sucrose, except for patients with history of sensitivities to IV iron preparations or multiple drug allergies 3

Ferric Carboxymaltose Administration

Dosing

• Can deliver large doses (up to 1000 mg) in a single infusion 1, 5
• Dosing is typically 15 mg/kg up to a maximum single dose of 750-1000 mg 6, 1

Administration Time

• Can be administered over just 15 minutes, allowing for complete iron repletion in a single visit 1, 2, 5
• No test dose is required 1
• Provides rapid improvement in hemoglobin levels and efficiently replenishes depleted iron stores 5

Low Molecular Weight Iron Dextran

Dosing and Administration

• Can be administered as a 1000 mg infusion in 250 mL of normal saline 2
• Should be administered over 1 hour 2, 1
• Requires a test dose due to black box warning for anaphylaxis in the United States 2, 1

Monitoring During Administration

• Monitor vital signs during and after infusion to detect potential reactions 3
• For minor infusion reactions:
  • Stop the infusion
  • Switch to hydration fluid to keep vein open
  • Monitor until resolution of symptoms 3
• After 15 minutes, rechallenge may be considered with careful monitoring if symptoms resolve 3
• If symptoms worsen or don't improve after 15 minutes, consider administering IV corticosteroid 3

Clinical Considerations

• Modern IV iron formulations have a low risk of serious adverse events 1
• Common side effects include arthralgia, hypotension, and injection site reactions 1, 5
• Avoid IV iron in patients with active infection 3
• When choosing between formulations, consider:
  • Number of visits required (single vs. multiple)
  • Total dose needed
  • Patient convenience
  • Cost-effectiveness 1, 2

Recommended Follow-up

• Monitor hemoglobin at baseline and 3-4 weeks post-infusion 1
• Target an increase in hemoglobin of at least 2 g/dL within 4 weeks 1
• Target transferrin saturation ≥20% and serum ferritin ≥100 ng/mL 1

While iron sucrose has a well-established safety profile, its limitation of 200 mg maximum single dose necessitates multiple visits. In contrast, ferric carboxymaltose allows for complete iron repletion in a single 15-minute visit, making it the more efficient and convenient option for most patients requiring IV iron therapy.