Venofer Dosing: Number of Rounds Required
For iron deficiency anemia, Venofer (iron sucrose) typically requires 5 rounds of 200 mg each (total 1000 mg) given over 2 weeks for hemodialysis patients, or 5 doses of 200 mg over 14 days for non-dialysis patients, though the exact number depends on your total iron deficit calculation. 1, 2
Dosing by Patient Population
Hemodialysis-Dependent CKD (HDD-CKD)
- Standard regimen: 100 mg undiluted IV over 2-5 minutes per dialysis session 2
- Total treatment course: 1000 mg total, which equals 10 rounds of 100 mg doses 2
- Administer early during dialysis (within first hour) 2
- Treatment may be repeated if iron deficiency recurs 2
Non-Dialysis Dependent CKD (NDD-CKD) or General Iron Deficiency Anemia
- Standard regimen: 200 mg IV over 2-5 minutes or as 15-minute infusion 1, 2
- Number of rounds: 5 doses of 200 mg given over a 14-day period (total 1000 mg) 2
- Alternative high-dose option: 500 mg diluted in 250 mL normal saline over 3.5-4 hours on Day 1 and Day 14 (2 rounds only), though this has limited experience 2
Peritoneal Dialysis-Dependent CKD (PDD-CKD)
- 3 divided doses over 28 days: 2
- Two 300 mg infusions over 1.5 hours, 14 days apart
- One 400 mg infusion over 2.5 hours, 14 days after the second dose
- Total: 3 rounds (1000 mg total) 2
Pediatric Patients (≥2 years)
- Maintenance dosing: 0.5 mg/kg (max 100 mg) every 2 weeks for HDD-CKD patients, or every 4 weeks for NDD-CKD/PDD-CKD patients 2
- Duration: 12 weeks of treatment 2
- This translates to 6 rounds for hemodialysis or 3 rounds for non-dialysis pediatric patients 2
Calculating Your Total Iron Deficit
Ganzoni Formula Method
- Formula: Body weight (kg) × [target Hb - actual Hb (g/dL)] × 0.24 + 500 mg 1, 3
- This formula tends to underestimate iron requirements in clinical practice 1
Simplified Dosing Approach (Preferred)
Translating Total Deficit to Number of Venofer Rounds
- If you need 1000 mg total: 5 rounds of 200 mg each 1
- If you need 1500 mg total: 7-8 rounds of 200 mg each 1
- If you need 2000 mg total: 10 rounds of 200 mg each 1
Administration Details
Maximum Single Dose Limitations
- Venofer maximum per dose: 200 mg 1
- This is a critical limitation compared to ferric carboxymaltose (which allows 1000 mg single doses) 1, 3
- Each 200 mg dose takes only 10 minutes to infuse 1
Practical Scheduling
- Doses can be given as frequently as daily, though alternate-day dosing may optimize absorption for oral iron 4
- For IV iron, the 5 doses over 14 days schedule (every 2-3 days) is standard 2
- Resuscitation equipment must be immediately available during all infusions 1, 3
Common Pitfalls to Avoid
Underdosing
- The most common error is stopping after 2-3 doses when patients need 5+ rounds to fully replete iron stores 1
- Always calculate total iron deficit before starting treatment 3
Not Monitoring Response
- Recheck hemoglobin, ferritin, and transferrin saturation at 4 weeks 3
- Expected response: Hb increase ≥2 g/dL within 4 weeks 3
- If target not achieved, investigate for ongoing blood loss or other causes 1, 3
Concurrent Oral Iron
- Do not give oral iron simultaneously with IV iron therapy 3
- Unabsorbed oral iron can cause GI inflammation and dysbiosis 1, 4
Ignoring Contraindications
- Never give IV iron during active bacterial infection 3
- Do not exceed transferrin saturation >50% or ferritin >800 μg/L 1, 5
- No test dose required for Venofer (unlike iron dextran) 1
Why Venofer Requires More Rounds Than Alternatives
Venofer's 200 mg maximum single dose necessitates 5-10 rounds for complete iron repletion, whereas ferric carboxymaltose can deliver 1000 mg in a single 15-minute infusion (1-2 total visits). 1, 3 This makes Venofer less convenient but more widely available and lower cost per gram of iron (£70.80 vs £217.50 for ferric carboxymaltose). 1