What dose of Venofer (iron sucrose) for a 36-year-old female with iron deficiency anemia and low ferritin?

From the Guidelines

For a 36-year-old female with low hemoglobin, hematocrit, and a ferritin level of 7 ng/mL, I recommend administering Venofer (iron sucrose) 200 mg intravenously once weekly for 5 weeks, for a total cumulative dose of 1000 mg, as the most effective treatment option to rapidly correct iron deficiency and improve quality of life, based on the most recent evidence from 1.

Key Considerations

• The patient's extremely low ferritin level indicates severe iron deficiency that requires prompt correction.
• Intravenous iron bypasses the limited absorption capacity of the gastrointestinal tract, allowing for faster repletion of iron stores and improvement in hemoglobin levels compared to oral iron supplementation.
• Venofer (iron sucrose) has a maximum single dose of 200 mg and a maximum weekly dose of 500 mg, with a minimum infusion time of 30 minutes for the maximum dose, as stated in 1.

Administration Guidelines

• Each dose should be diluted in 100 mL of normal saline and infused over 30 minutes.
• Prior to initiating therapy, ensure the patient has no history of allergic reactions to iron products and monitor vital signs before, during, and after the infusion.
• The first dose should be given as a test dose of 25 mg over 15 minutes with careful monitoring for hypersensitivity reactions.

Potential Side Effects

• Common side effects include transient hypotension, nausea, and injection site reactions, as reported in 1.

Underlying Cause Evaluation

• Additionally, the patient should be evaluated for the underlying cause of iron deficiency, such as menorrhagia, gastrointestinal bleeding, or malabsorption.

Evidence-Based Decision

• The recommendation is based on the most recent and highest quality study, 1, which provides the most up-to-date guidelines for intravenous iron formulations, including Venofer (iron sucrose).

From the FDA Drug Label

2 DOSAGE & ADMINISTRATION Venofer must only be administered intravenously either by slow injection or by infusion. The dosage of Venofer is expressed in mg of elemental iron. Each mL contains 20 mg of elemental iron.

1. 3 Adult Patients with Non-Dialysis Dependent-Chronic Kidney Disease (NDD-CKD) Administer Venofer 200 mg undiluted as a slow intravenous injection over 2 to 5 minutes or as an infusion of 200 mg in a maximum of 100 mL of 0. 9% NaCl over a period of 15 minutes. Administer on 5 different occasions over a 14 day period.

The patient is a 36-year-old female with low hemoglobin and hematocrit, as well as ferritin of 7, which indicates iron deficiency.

• The recommended dose for adult patients with Non-Dialysis Dependent-Chronic Kidney Disease (NDD-CKD) is 200 mg of Venofer, administered as an infusion in a maximum of 100 mL of 0.9% NaCl over a period of 15 minutes.
• The treatment should be administered on 5 different occasions over a 14-day period 2. Given the information provided, the patient's condition does not explicitly match any of the described patient groups (HDD-CKD, NDD-CKD, PDD-CKD), but since there is no information about the patient being on dialysis, the NDD-CKD dosing regimen might be considered, but with caution and clinical judgment.

From the Research

Venofer Infusion for Low Hemoglobin and Hematocrit

• For a 36-year-old female with low hemoglobin and hematocrit, as well as a ferritin level of 7, Venofer (iron sucrose) can be considered as a treatment option 3.
• The dosage of Venofer to infuse can vary depending on the patient's iron deficiency and medical history, but typical doses range from 100 mg to 300 mg administered over several minutes to 60 minutes 3.

Comparison of Intravenous Iron Products

• A study comparing the safety profiles of intravenous iron products, including iron sucrose, found that iron sucrose appears to have a favorable safety profile compared to other agents such as iron dextran and sodium ferric gluconate 4.
• Another study found that iron sucrose was associated with a lower incidence of life-threatening anaphylactoid reactions and non-anaphylactoid reactions, such as hypotension and nausea, compared to other intravenous iron products 3.

Oxidative Stress Markers

• A study comparing oxidative stress markers after intravenous administration of iron dextran, sodium ferric gluconate, and iron sucrose found that iron sucrose was associated with lower levels of non-transferrin-bound iron and markers of oxidative stress compared to sodium ferric gluconate 5.
• The study suggests that iron sucrose may be a safer option for patients undergoing hemodialysis, as it is associated with lower levels of oxidative stress 5.

Treatment Guidelines

• The National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) recommends that hemodialysis patients with serum ferritin below 100 ng/mL or transferrin saturations below 18% receive supplementation with parenteral iron in excess of 1.0 g to achieve optimal response in hemoglobin and hematocrit levels 6.