What is the typical dose of intravenous (IV) iron for patients with iron deficiency anemia?

Typical Dosing of Intravenous Iron for Iron Deficiency Anemia

For patients with iron deficiency anemia, the standard intravenous iron dose is typically 1,000-1,500 mg total, administered according to the specific formulation guidelines. 1, 2, 3

Formulation-Specific Dosing Recommendations

Ferric Carboxymaltose (Injectafer)

• For patients ≥50 kg: 750 mg IV in two doses separated by at least 7 days (total 1,500 mg) 2
• Alternative dosing: 15 mg/kg up to 1,000 mg as a single dose 2
• For patients <50 kg: 15 mg/kg in two doses separated by at least 7 days 2
• Administration: Undiluted slow IV push or diluted in up to 250 mL normal saline given over at least 15 minutes 2

Iron Sucrose

• Standard dose: 200 mg per administration as IV push over 10 minutes 4
• Multiple doses given until calculated total iron requirement is met 4
• For hemodialysis patients: 100-200 mg directly into dialysis line 2-3 times weekly 4
• Pediatric dosing (for chronic kidney disease):
  • <10 kg: 25 mg per dose
  • 10-20 kg: 50 mg per dose

  • 20 kg: 100 mg per dose 1, 4

Iron Dextran

• For adult hemodialysis patients: 100 mg weekly for 10 doses (total 1,000 mg) 1
• For chronic kidney disease patients not on dialysis: 500-1,000 mg as a single infusion, repeated as needed 1
• Pediatric dosing (hemodialysis):
  • <10 kg: 25 mg per dose for 10 doses
  • 10-20 kg: 50 mg per dose for 10 doses

  • 20 kg: 100 mg per dose for 10 doses 1

Total Iron Deficit Calculation

Research indicates that the average iron deficit in patients with iron deficiency anemia is approximately 1,500 mg, suggesting that a total cumulative dose of 1,000 mg may be insufficient for complete iron repletion in many patients 3. A dose of 1,500 mg more closely matches the actual iron deficit in most patients 3.

Administration Considerations

• Test dose required for iron dextran but not for newer formulations like iron sucrose or ferric carboxymaltose 4
• Monitor vital signs during and after administration 5
• Avoid administration in patients with active infection 4
• Resuscitation facilities should be available during administration despite low risk profile 4

Monitoring Response

• Measure hemoglobin, transferrin saturation, and serum ferritin 4-8 weeks after the last infusion 1
• Avoid measuring iron parameters within 4 weeks of total dose infusion as circulating iron interferes with accurate results 1
• Expect hemoglobin to increase by 1-2 g/dL within 4-8 weeks of therapy 4
• For maintenance, monitor iron status every 3 months 1

Efficacy Considerations

• IV iron administration results in more rapid improvement in hemoglobin levels compared to oral iron 6
• Single high-dose administration (1,000-1,500 mg) has been shown to be effective and well-tolerated 5, 7
• Patients receiving 1,500 mg total dose have lower retreatment requirements compared to those receiving 1,000 mg (5.6% vs 11.1%) 3

Common Pitfalls to Avoid

• Measuring iron parameters too soon after IV iron administration (wait at least 7 days for doses of 100-125 mg, and 14 days for doses of 1,000 mg or more) 1
• Underdosing patients (studies show 1,000 mg may be insufficient for complete iron repletion) 3
• Continuing IV iron when ferritin >800 ng/mL or transferrin saturation >50% (withhold for up to 3 months and reassess) 1

In conclusion, while specific dosing depends on the iron formulation used, most adult patients with iron deficiency anemia require a total of 1,000-1,500 mg of intravenous iron to adequately replenish iron stores and correct anemia 1, 2, 3.