Iron Sucrose Dosing for Iron Deficiency Anemia
For iron deficiency anemia, administer iron sucrose 200 mg intravenously per infusion, given 2-3 times weekly, for a total cumulative dose of 1000-1500 mg based on body weight and hemoglobin level. 1, 2
Standard Dosing Protocol
Initial Treatment Phase
- Maximum single dose: 200 mg per infusion, administered over 30 minutes minimum 3, 4
- Frequency: 2-3 times per week on non-consecutive days 1, 5
- Total cumulative dose calculation 1, 2:
- Hemoglobin 10-12 g/dL and body weight <70 kg: 1000 mg total
- Hemoglobin 10-12 g/dL and body weight ≥70 kg: 1500 mg total
- Hemoglobin 7-10 g/dL and body weight ≥70 kg: 2000 mg total
Administration Details
- No test dose required - unlike iron dextran, iron sucrose does not necessitate test dosing 1, 6
- Administer as slow intravenous infusion over minimum 30 minutes for 200 mg doses 3, 4
- Can be given undiluted as IV push over 5 minutes for 100 mg doses 7
- Requires 4-7 visits to achieve complete iron repletion with standard 200 mg dosing 8
Special Population Adjustments
Hemodialysis Patients
- Induction: 100-300 mg weekly for total dose of 1000-1200 mg 1
- Maintenance: 2 mg/kg once or twice monthly 1
Pediatric Patients (≥2 years)
- Doses of 100-200 mg per infusion have been safely used 1, 5
- Administer on alternate days, up to 3 times weekly 5
- Total doses ranging from 200-1200 mg depending on severity 5
Monitoring Requirements
Baseline Assessment
- Hemoglobin, transferrin saturation (TSAT), and serum ferritin before initiating therapy 1, 2
- Confirm iron deficiency: TSAT <20% and ferritin <100 ng/mL in inflammatory conditions 3
Response Monitoring
- Hemoglobin check at 3-4 weeks: expect increase of ≥2 g/dL 1, 2
- Target iron parameters: TSAT ≥20% and ferritin ≥100 ng/mL 2
- Avoid checking iron parameters within first 4 weeks post-administration as circulating iron interferes with assays 1
- Follow-up monitoring at 3-month intervals for first year 8
Safety Monitoring
- Observe patient for minimum 30 minutes after each infusion for hypersensitivity reactions 4
- Monitor blood pressure during and after administration 4, 7
- Avoid iron overload: maintain TSAT <50% and ferritin <800 μg/L 1
Clinical Advantages and Limitations
Why Iron Sucrose May Not Be Optimal
While iron sucrose is effective and safe, newer formulations like ferric carboxymaltose allow 750-1000 mg in a single 15-minute infusion compared to iron sucrose's requirement for multiple visits 8. This represents a significant convenience advantage, though iron sucrose remains a valid option when newer formulations are unavailable or cost-prohibitive.
Safety Profile
- Anaphylaxis risk: exceedingly rare (<1:200,000 administrations) 3
- Common side effects (≥2%): diarrhea, nausea, headache, dizziness, hypotension, injection site reactions 4
- Gastrointestinal tolerability: superior to oral iron, with only 4.5% discontinuation rate versus 20.8% for oral iron sulfate 9
- Safe in patients with previous iron dextran sensitivity 7
Critical Clinical Pearls
First-line IV iron indications 1, 2:
- Hemoglobin <10 g/dL
- Active inflammatory bowel disease
- Previous oral iron intolerance
- Need for erythropoiesis-stimulating agents
Avoid in first trimester of pregnancy and use caution with active infections 8
The risk of iron overload in chronically bleeding patients (e.g., inflammatory bowel disease) is intrinsically low 1
Personnel and therapies for treating serious hypersensitivity reactions must be immediately available 4