What is the protocol for ordering IV Venofer (iron sucrose)?

How to Order IV Venofer (Iron Sucrose)

Order Venofer as 200 mg diluted in 100 mL of 0.9% normal saline, infused over 30-60 minutes, with no test dose required for most patients. 1, 2

Dosing Parameters

• Maximum single dose: 200 mg 1, 2
• Maximum weekly dose: 500 mg 1, 2
• For higher doses (300-500 mg): Dilute in maximum 250 mL of 0.9% NaCl 1
• Total treatment course: Typically 1000 mg total iron delivered over multiple sessions 3, 4

Administration Protocol

Standard Infusion Method

• Dilute 200 mg in 100 mL of 0.9% normal saline 2
• Infusion time: 30-60 minutes for 200 mg dose 1, 2
• Alternative rapid administration: 200 mg can be given as slow IV push over 2-5 minutes (FDA-approved) or 10 minutes (EMA-approved), though longer infusion is generally preferred 1, 2

Monitoring During Infusion

• Start infusion slowly for first 5 minutes to monitor for reactions 1
• Alternative: Administer 25 mg test dose over 5 minutes, then wait before continuing with remainder 1
• Monitor vital signs during and for at least 15 minutes after infusion completion 2, 5

Test Dose Requirements

Test doses are NOT routinely required for iron sucrose, unlike iron dextran 3, 6, 4. However, consider a 25 mg test dose in specific circumstances:

• Patients with history of sensitivity to other IV iron preparations 2, 3
• Patients with multiple drug allergies 2, 3
• Patients with documented hypersensitivity to iron dextran (though iron sucrose can still be safely used) 3, 7

Contraindications

• Active infection: Do not administer IV iron to patients with active infection 2, 3
• Known hypersensitivity to iron sucrose 3

Frequency of Administration

• Typical regimen: 200 mg IV every 2-3 weeks until total required dose achieved 3
• Alternative intensive regimen: 100 mg three times weekly for 3 weeks (total 900-1000 mg) 8, 4
• Maximum frequency: Do not exceed 500 mg per week 1, 2

Safety Considerations

Common Adverse Effects to Monitor

• Hypotension or hypertension 2, 3
• Headache and dizziness 3
• Nausea 3
• Flushing and abdominal cramps 2, 5

Serious Reactions (Rare)

• Anaphylaxis may occur (frequency 0.1-1%), though markedly lower than iron dextran 3, 6
• Ensure resuscitation facilities available during administration 2
• Life-threatening reactions are extremely uncommon with iron sucrose compared to iron dextran 6, 4

Management of Minor Infusion Reactions

If minor reaction occurs during infusion:

1. Stop the infusion immediately 2
2. Switch to hydration fluid to keep vein open 2
3. Monitor patient - most reactions are self-limiting and resolve spontaneously 2, 5
4. After 15 minutes: Consider rechallenge with careful monitoring 2
5. If symptoms persist or worsen: Administer IV corticosteroid (e.g., hydrocortisone) 2

Important Clinical Pearls

• No dialysis removal: Iron sucrose is not dialyzable through high-efficiency or high-flux membranes, so timing relative to dialysis is not critical 8, 9
• Lab monitoring timing: Transferrin and ferritin levels can be reliably measured 48 hours after IV administration 6
• Well-established safety profile: Iron sucrose has been used safely for over 50 years with relatively few serious adverse effects compared to other IV iron preparations 2, 5, 6
• No black-box warning: Unlike iron dextran, iron sucrose carries no black-box warning 3, 6