How is encicarb iron (iron sucrose) administered?

How to Administer Iron Sucrose (Venofer)

Iron sucrose should be administered intravenously at a maximum single dose of 200 mg, given either as an undiluted slow IV push over 2-5 minutes or diluted in up to 100 mL normal saline and infused over 15-30 minutes, without requiring a test dose. 1, 2

Standard Administration Protocol

Dosing Parameters

• Maximum single dose: 200 mg of elemental iron per administration 1, 2
• Maximum weekly dose: 500 mg 1
• Typical treatment course: 100-300 mg administered 2-3 times weekly until total iron deficit is repleted (usually 1000-1200 mg total) 3

Two Administration Methods

Method 1: IV Push (Most Convenient)

• Administer 200 mg undiluted over 5 minutes as a slow IV push 4
• The 10-minute bolus administration is licensed and more convenient than infusion 2
• No test dose required 3, 5

Method 2: IV Infusion

• Dilute dose in normal saline (100 mL for 500 mg dose, 250 mL for 300-500 mg doses) 1
• Infuse over minimum 15-30 minutes 1
• For 500 mg: use 100 mL saline, infuse over minimum 6 minutes 1

Critical Safety Considerations

No Test Dose Required

• Unlike iron dextran, iron sucrose does not require a test dose 3, 5
• Test doses are only recommended for patients with history of sensitivities to IV iron or multiple drug allergies 2
• Anaphylaxis risk is exceedingly rare (<1:200,000 administrations) 3

Monitoring During Administration

• Monitor vital signs during and after infusion 2
• Observe patients for at least 30 minutes following each injection 1
• Have resuscitation facilities immediately available 2

Managing Minor Infusion Reactions

If a reaction occurs:

1. Stop the infusion immediately and switch to hydration fluid 2
2. Monitor continuously - most reactions are self-limiting and resolve spontaneously 2
3. Wait 15 minutes before considering rechallenge 2
4. Administer IV corticosteroid (hydrocortisone) if symptoms persist or worsen after 15 minutes 2

Calculating Total Iron Deficit

Based on body weight and hemoglobin:

• Hb 10-12 g/dL and ≥70 kg: 1500 mg total dose 3
• Hb 7-10 g/dL and ≥70 kg: 2000 mg total dose 3
• Hb 10-12 g/dL and <70 kg: 1000 mg total dose 6

Given the 200 mg maximum single dose, this requires 5-10 separate administrations over several weeks 6, 3

Contraindications and Precautions

Absolute Contraindications

• Active bacteremia or ongoing infection 1, 2
• Known hypersensitivity to iron sucrose 1
• Anemia not due to iron deficiency 1
• Evidence of iron overload 1

Use With Caution

• Patients with drug allergies, severe asthma, eczema, or atopic allergies 1
• Immune/inflammatory conditions (SLE, rheumatoid arthritis) 1
• First trimester of pregnancy 1

Monitoring Response to Treatment

Timing of Laboratory Assessment

• Do NOT check iron parameters within 4 weeks of administration - circulating iron interferes with assays 1, 3
• Check hemoglobin at 3-4 weeks post-infusion 6
• Reassess iron status at 3 months after completion of therapy 1

Expected Response

• Hemoglobin should increase by at least 2 g/dL within 4 weeks 6, 3
• Target transferrin saturation ≥20% and ferritin ≥100 ng/mL 6, 3

Maintenance Therapy

For dialysis patients requiring ongoing iron supplementation:

• 2 mg/kg once or twice monthly 3
• Avoid iron overload by maintaining transferrin saturation <50% and ferritin <800 μg/L 3

Key Clinical Pitfalls to Avoid

1. Don't over-dilute: Maximum 250 mL saline for doses up to 500 mg 1
2. Don't give >200 mg per single dose: This exceeds safety guidelines 1, 2
3. Don't check labs too early: Wait minimum 4 weeks to avoid spurious results 1, 3
4. Don't use in active infection: Defer treatment until infection resolves 1, 2