What is the recommended dosing regimen for daily Venofer (iron sucrose) infusions?

Venofer (Iron Sucrose) Daily Infusion Dosing

Daily Venofer infusions are not recommended based on FDA-approved dosing regimens; the standard approach is 100-200 mg administered 2-3 times weekly, not daily. 1

FDA-Approved Dosing Regimens

The FDA label provides specific dosing schedules that do not include daily administration 1:

Hemodialysis-Dependent CKD (HDD-CKD)

• 100 mg per hemodialysis session (typically 3 times weekly), administered as:
  • Slow IV injection over 2-5 minutes (undiluted), OR
  • Infusion in maximum 100 mL 0.9% NaCl over 15 minutes 1
• Total treatment course: 1000 mg 1

Non-Dialysis Dependent CKD (NDD-CKD)

• 200 mg on 5 different occasions over 14 days (approximately every 2-3 days, not daily) 1
• Administration options:
  • Slow IV injection over 2-5 minutes (undiluted), OR
  • Infusion in maximum 100 mL 0.9% NaCl over 15 minutes 1

Peritoneal Dialysis-Dependent CKD (PDD-CKD)

• Three divided doses over 28 days:
  • 300 mg over 1.5 hours (Day 1)
  • 300 mg over 1.5 hours (Day 14)
  • 400 mg over 2.5 hours (Day 28) 1

Maximum Dosing Limits

Individual doses above 300 mg are not recommended per NCCN guidelines 2, and the maximum weekly dose is 500 mg per Kidney International guidelines 3.

Safety Considerations for Frequent Dosing

Contraindications

• Active infection is an absolute contraindication to IV iron therapy 2, 3

Monitoring Requirements

• Monitor vital signs during and after each infusion to detect hypotension, flushing, or other reactions 3
• Resuscitation facilities should be available during administration due to potential anaphylaxis risk 3

Test Dose Recommendations

• Test doses are not required for iron sucrose per FDA labeling 1
• However, test doses (25 mg slow IV push) are strongly recommended for patients with prior sensitivities to IV iron preparations or multiple drug allergies 2, 3

Clinical Evidence on Dosing Frequency

Research supports less frequent dosing intervals:

• Weekly dosing of 200 mg has been shown effective and safe in iron deficiency anemia, with 84-94% response rates 4
• Twice-weekly 100 mg dosing followed by weekly maintenance effectively increases hemoglobin and iron parameters in hemodialysis patients 5
• 2-minute bolus injection of 200 mg has been safely administered in 2,297 injections with only 2.5% adverse events (excluding transient metallic taste) 6

Practical Algorithm for Iron Sucrose Administration

For most patients requiring frequent iron supplementation:

1. Hemodialysis patients: 100 mg with each dialysis session (3x/week maximum) 1
2. Non-dialysis CKD patients: 200 mg every 2-3 days (5 doses over 14 days) 1
3. Maintenance dosing: Weekly or every-other-week dosing once iron stores replete 3, 5

Daily dosing exceeds FDA-approved regimens and maximum weekly dose recommendations, increasing risk without established benefit.

Common Pitfalls to Avoid

• Do not exceed 200 mg per individual dose in routine practice 2, 1
• Do not administer more than 500 mg per week 3
• Do not give IV iron to patients with active infection 2, 3
• Do not assume daily dosing is safer—less frequent, larger doses (up to 200 mg) are well-tolerated and more convenient 6, 7