Venofer (Iron Sucrose) Dosing
The maximum single dose of Venofer is 200 mg, with a maximum weekly dose of 500 mg, administered either as a slow IV push over 2-5 minutes (FDA) or as an infusion over 15-30 minutes depending on regulatory guidance. 1, 2
Standard Dosing Parameters
Maximum Dose Limits
- Single dose maximum: 200 mg elemental iron 1, 2
- Weekly dose maximum: 500 mg elemental iron 1, 2
- Concentration: 20 mg elemental iron per mL, available in 100 mg (5 mL) vials 2
Administration Methods
For Direct IV Injection (Slow IV Push):
- Administer undiluted at 100 mg over 2-5 minutes per FDA guidelines 2
- Doses of 100 mg minimize the risk of arthralgia-myalgia reactions 2
For IV Infusion:
- Dilute in normal saline solution 2
- FDA recommends 15 minutes for doses up to 200 mg 1, 2
- European Medicines Agency recommends 30 minutes for doses up to 200 mg 1, 2
- For doses of 300-500 mg, dilute in maximum 250 mL of 0.9% NaCl 3
Practical Dosing Strategy
Typical Maintenance Dosing
- 100 mg per dose is the typical administration that minimizes adverse effects 2
- This can be given weekly or as clinically indicated based on iron parameters 2
Higher Dose Regimens
- 200 mg weekly for 5 doses has been studied and shown effective in CKD patients 4, 5
- 250 mg monthly has been used successfully in stable hemodialysis patients on erythropoietin 6
Important Safety Considerations
Pre-Administration Requirements
- Test doses are NOT required for iron sucrose 7
- However, test doses are recommended for patients with history of sensitivities to IV iron or multiple drug allergies 3
- Do not administer to patients with active infection 3
- Ensure resuscitation facilities are available during administration 3
Monitoring During Administration
- Monitor vital signs during and after infusion 3, 2
- Watch for hypotension, flushing, abdominal cramps, and arthralgias/myalgias 3, 2
Dose-Related Adverse Effects
- Arthralgias and myalgias are dose-related and rarely occur with doses ≤100 mg 2
- Hypotension and flushing are rare 2
- Abdominal cramps are rare, particularly when co-administered with ACE inhibitors 2
Clinical Monitoring Parameters
Laboratory Follow-Up
- Monitor hemoglobin, ferritin, and transferrin saturation to assess response 2
- Transferrin and ferritin levels can be measured reliably 48 hours after IV administration 7
- Free iron may occur if 100 mg is administered when transferrin levels are <180 mg/dL 2
Management of Infusion Reactions
- For minor reactions: stop infusion, switch to hydration fluid, and monitor 3
- Most reactions are self-limiting and resolve spontaneously 3
- After 15 minutes, rechallenge may be considered with careful monitoring 3
- If symptoms persist or worsen after 15 minutes, consider IV hydrocortisone 3
Common Pitfalls to Avoid
- Avoid exceeding 200 mg single dose to minimize arthralgia-myalgia reactions 1, 2
- Do not exceed 500 mg weekly as per guideline recommendations 1
- Avoid administration in patients with active infection 3
- Do not assume test doses are required - iron sucrose carries no black-box warning and test doses are not mandatory 7