What is the recommended dosage for Venofer (iron sucrose) infusion?

Venofer (Iron Sucrose) Dosing Guidelines

The recommended dosage of Venofer depends on the clinical indication: for hemodialysis-dependent chronic kidney disease (HDD-CKD), administer 100 mg undiluted as a slow IV injection over 2-5 minutes or as an infusion over at least 15 minutes per dialysis session; for non-dialysis dependent CKD (NDD-CKD), administer 200 mg over 2-5 minutes or as a 15-minute infusion on 5 occasions over 14 days; and for peritoneal dialysis-dependent CKD (PDD-CKD), give 300 mg twice (14 days apart) followed by 400 mg 14 days later. 1

Standard Adult Dosing by Clinical Setting

Hemodialysis-Dependent CKD (HDD-CKD)

• Dose: 100 mg per hemodialysis session 1
• Administration options:
  • Undiluted slow IV push over 2-5 minutes 1
  • Diluted in maximum 100 mL of 0.9% NaCl over at least 15 minutes 1
• Timing: Administer early during dialysis session (generally within first hour) 1
• Total course: 1000 mg total treatment course; may repeat if iron deficiency recurs 1

Non-Dialysis Dependent CKD (NDD-CKD)

• Dose: 200 mg per administration 1
• Frequency: 5 doses over a 14-day period 1
• Administration options:
  • Undiluted slow IV push over 2-5 minutes 1
  • Diluted in maximum 100 mL of 0.9% NaCl over 15 minutes 1
• Alternative regimen: 500 mg diluted in maximum 250 mL of 0.9% NaCl over 3.5-4 hours on Day 1 and Day 14 (limited experience) 1

Peritoneal Dialysis-Dependent CKD (PDD-CKD)

• Regimen: Three divided doses within 28 days 1:
  • 300 mg over 1.5 hours (Day 1)
  • 300 mg over 1.5 hours (Day 14)
  • 400 mg over 2.5 hours (Day 28)
• Dilution: Maximum 250 mL of 0.9% NaCl 1

Pediatric Dosing (≥2 Years of Age)

HDD-CKD Maintenance Treatment

• Dose: 0.5 mg/kg (not to exceed 100 mg per dose) 1
• Frequency: Every 2 weeks for 12 weeks 1
• Administration: Undiluted over 5 minutes or diluted in 0.9% NaCl at 1-2 mg/mL over 5-60 minutes 1

NDD-CKD or PDD-CKD on Erythropoietin

• Dose: 0.5 mg/kg (not to exceed 100 mg per dose) 1
• Frequency: Every 4 weeks for 12 weeks 1
• Administration: Same as HDD-CKD pediatric dosing 1

Cancer-Related Anemia Dosing

For cancer patients with chemotherapy-induced anemia:

• Dose: 200 mg IV over 60 minutes 2
• Frequency: Repeated dosing every 2-3 weeks 2
• Maximum single dose: Individual doses above 300 mg are not recommended 2
• Maximum total dose: 1000 mg 2

Critical Safety Parameters

Maximum Dosing Limits

• Single dose maximum: 200 mg to minimize dose-related adverse effects 3, 4
• Weekly maximum: 500 mg 3, 4
• Typical administration: 100 mg per dose minimizes risk of arthralgia-myalgia reactions 3

Test Dose Requirements

• Not required for iron sucrose 2, 4
• Recommended for patients with history of sensitivities to IV iron preparations or multiple drug allergies 2, 4
• Test dose protocol (if used): 25 mg slow IV push, observe before proceeding 2

Absolute Contraindications

• Active bacteremia: Do not administer during active infection 2, 4
• Chronic infection alone is not an absolute contraindication if risk/benefit favors treatment 4

Administration Technique

Preparation

• Each mL contains 20 mg elemental iron 3, 1
• Available in 100 mg (5 mL) vials 3
• Dilute in normal saline solution for infusion 3

Infusion Monitoring

• Start infusion slowly for first 5 minutes to monitor for reactions 4
• Monitor vital signs during and after infusion 4
• Resuscitation facilities should be available 4

Managing Minor Infusion Reactions

• Stop the infusion immediately 4
• Switch to hydration fluid to keep vein open 4
• Monitor patient; most reactions are self-limiting and resolve spontaneously 4
• After 15 minutes, rechallenge may be considered with careful monitoring 4
• If symptoms persist or worsen after 15 minutes, consider IV hydrocortisone 4

Common Pitfalls to Avoid

• Do not exceed 200 mg single dose to minimize anaphylactoid reactions 4
• Avoid rapid administration of doses >100 mg; use appropriate infusion times 3, 1
• Do not dilute below 1 mg/mL concentration in pediatric patients 1
• Free iron may occur if 100 mg administered when transferrin <180 mg/dL 3
• Multiple visits required: Iron sucrose typically requires 4-7 visits for complete iron replenishment, unlike newer formulations 5

Monitoring Parameters

• Hemoglobin: Baseline and 3-4 weeks post-infusion 3
• Ferritin: Target ≥100 ng/mL 3
• Transferrin saturation: Target ≥20% 3
• Follow-up: 3-month intervals for first year 3

Adverse Effects Profile

• Incidence: Approximately 0.5% hypersensitivity-type and infusion reactions 4
• Common effects: Hypotension, nausea, vomiting, diarrhea 2, 4
• Rare effects: Hypotension, flushing, abdominal cramps (particularly with ACE inhibitors), arthralgias/myalgias 3
• Hypophosphatemia: Occurs in approximately 1% of patients (significantly lower than ferric carboxymaltose at 58%) 4