What is the standard dosing for Venofer (iron sucrose) for treating iron deficiency anemia?

Standard Venofer (Iron Sucrose) Dosing

The standard dosing for Venofer is 200 mg administered intravenously over 10-15 minutes as a single dose, with a maximum weekly dose of 500 mg, though typical administration uses 100 mg per dose to minimize adverse effects. 1, 2

FDA-Approved Administration Routes

Venofer contains 20 mg of elemental iron per mL and is available in 100 mg (5 mL) and 200 mg (10 mL) single-dose vials. 2, 3

Two administration methods are approved:

• Slow IV push (undiluted): 100 mg administered over 2-5 minutes 2
• IV infusion (diluted): Up to 200 mg diluted in normal saline, administered over 15 minutes (FDA) or 30 minutes (European Medicines Agency) 1, 2

Maximum Dosing Parameters

Critical dosing limits to prevent adverse effects:

• Maximum single dose: 200 mg 1, 2
• Maximum weekly dose: 500 mg 1, 2
• For doses of 300-500 mg: Must be diluted in maximum 250 mL of 0.9% NaCl 4

Optimal Dosing Strategy

The 100 mg per dose regimen is preferred in clinical practice because it minimizes dose-related adverse effects including arthralgias, myalgias, hypotension, and flushing, which are rare at doses ≤100 mg but increase with higher doses. 1, 2

Practical dosing approach:

• Administer 100 mg once or twice weekly until iron deficiency is corrected 1, 2
• Total cumulative dose typically 1000 mg for most patients 1, 5
• Monitor hemoglobin, ferritin, and transferrin saturation to assess response 2

Population-Specific Considerations

Chronic Kidney Disease patients (hemodialysis):

• 100 mg per dialysis session (typically 3 times weekly) is standard 1
• Doses >100 mg increase risk of arthralgias/myalgias 1

Non-dialysis CKD and predialysis patients:

• 200 mg weekly for 5 doses (total 1000 mg) is effective 6
• Can be combined with low-dose erythropoietin for faster correction 6

Cancer patients:

• Total doses in range of 1000 mg iron administered in divided doses 1
• Maximum single dose remains 200 mg 1

Safety Monitoring Requirements

Mandatory precautions during administration:

• Resuscitation facilities must be immediately available, as anaphylaxis may occur with any IV iron preparation 1, 4, 3
• Monitor vital signs during and for at least 30 minutes after infusion until clinically stable 4, 3
• Test doses are NOT required for iron sucrose, unlike iron dextran, but consider in patients with history of sensitivities to IV iron or multiple drug allergies 4

Management of minor infusion reactions:

• Stop infusion and switch to hydration fluid 4
• Monitor for 15 minutes; most reactions are self-limiting 4
• May rechallenge after 15 minutes with careful monitoring 4
• If symptoms persist or worsen, administer IV hydrocortisone 4

Common Pitfalls to Avoid

Do not exceed 200 mg single dose - higher doses significantly increase risk of dose-related adverse effects including arthralgias, myalgias, and hypotension. 1, 2

Avoid administration in patients with active infection - defer IV iron therapy until infection is controlled. 4

Monitor for hypotension - particularly when co-administered with ACE inhibitors, which increases risk of abdominal cramps and hypotension. 2

Do not administer to patients with iron overload - regularly monitor hematologic parameters and ferritin levels to prevent excessive iron accumulation. 3

Free iron may occur if 100 mg is administered when transferrin levels are <180 mg/dL - check transferrin saturation before dosing. 2