What is the appropriate dosing of Ferrlecit (sodium ferric gluconate complex in sucrose) in a 91-year-old patient?

From the Guidelines

The appropriate dosing of Ferrlecit (sodium ferric gluconate complex in sucrose) in a 91-year-old patient is 125 mg as a maximum single dose, with a minimum infusion time of 60 minutes 1.

Key Considerations

• The dosing of Ferrlecit should be based on the patient's individual needs and medical history, taking into account the potential for adverse effects such as hypotension and flushing 1.
• The maximum single dose of Ferrlecit is 125 mg, and it is recommended to infuse this dose over 60 minutes to minimize the risk of adverse effects 1.
• The use of Ferrlecit in patients with chronic kidney disease (CKD) has been studied, and it has been shown to be effective in increasing hemoglobin levels and reducing the need for erythropoiesis-stimulating agents (ESAs) 1.
• It is essential to monitor the patient's iron stores and adjust the dosing of Ferrlecit accordingly to avoid oversaturation of transferrin and potential adverse effects 1.

Administration Guidelines

• Ferrlecit should be administered intravenously, diluted in 50-100 mL of saline, and infused over 30-60 minutes 1.
• The patient should be monitored for signs of adverse effects, such as hypotension, flushing, and loin pain, during and after the infusion 1.
• It is recommended to start with a lower dose and gradually increase as needed and tolerated, to minimize the risk of adverse effects 1.

From the FDA Drug Label

2.2 Adult Dosage and Administration The recommended dosage of Ferrlecit for the repletion treatment of iron deficiency in hemodialysis patients is 10 mL of Ferrlecit (125 mg of elemental iron).

The appropriate dosing of Ferrlecit in a 91-year-old patient is 10 mL of Ferrlecit (125 mg of elemental iron), which may be diluted in 100 mL of 0.9% sodium chloride administered by intravenous infusion over 1 hour per dialysis session, or administered undiluted as a slow intravenous injection (at a rate of up to 12.5 mg/min) per dialysis session 2.

• The treatment may be repeated if iron deficiency reoccurs.
• For repletion treatment, most patients may require a cumulative dose of 1000 mg of elemental iron administered over 8 dialysis sessions.
• It is also noted that individual doses exceeding 125 mg may be associated with a higher incidence and/or severity of adverse events.

From the Research

Dosing of Ferrlecit in a 91-year-old patient

• The recommended dose of Ferrlecit (sodium ferric gluconate complex in sucrose) is 62.5-125 mg per treatment, which is suitable for haemodialysis (HD) patients 3.
• However, there is evidence that higher doses of Ferrlecit, up to 250 mg or 500 mg, can be safe and effective in certain patients, including those with chronic renal failure or renal transplant patients 3, 4, 5.
• A study on elderly hospital inpatients without terminal kidney failure found that Ferrlecit was safe and effective in treating iron-deficiency anemia, with no serious adverse reactions reported 6.
• The safety and efficacy of Ferrlecit in patients over 75 years old is not well established, as most studies have included patients with a younger age range 3, 6, 4, 5, 7.
• It is essential to consider the patient's individual needs and medical history when determining the appropriate dose of Ferrlecit, and to monitor for potential adverse reactions 3, 6, 4, 5, 7.

Key Considerations

• The patient's age and medical history should be taken into account when determining the dose of Ferrlecit 6.
• Higher doses of Ferrlecit may be necessary to achieve optimal response in hemoglobin and hematocrit levels 7.
• Monitoring for potential adverse reactions, such as nausea, vomiting, and hypotension, is crucial when administering Ferrlecit 3, 6, 4, 5, 7.