Iron Sucrose IV Administration Protocol
Iron sucrose should be administered at a maximum single dose of 200 mg per infusion, given as a slow intravenous infusion, with no test dose required. 1
Dosing Strategy
Calculate total iron deficit based on hemoglobin level and body weight using the simplified dosing scheme:
Hemoglobin 10-12 g/dL (women) or 10-13 g/dL (men):
Hemoglobin 7-10 g/dL:
Hemoglobin <7 g/dL:
- Add 500 mg to the above doses 2
Administration Protocol
Administer iron sucrose at 200 mg per infusion session, repeated weekly until the total calculated dose is delivered. 3, 4
- Each 200 mg dose should be given as a slow IV infusion 1
- No test dose is required before administration 1
- Resuscitation facilities must be available during all infusions 2
- The FDA label confirms iron sucrose is dissociated into iron and sucrose following IV administration, with an elimination half-life of 6 hours 5
Monitoring Parameters
Check hemoglobin and iron indices at 4 weeks to assess response, then every 3 months for 1 year, and annually thereafter. 2
- Expected response: Hemoglobin increase of at least 2 g/dL within 4 weeks 1, 2
- Target: Normalize hemoglobin levels and iron stores 1
- Re-treatment criteria: Initiate when serum ferritin drops below 100 μg/L or hemoglobin falls below 12 g/dL (women) or 13 g/dL (men) 1
Safety Monitoring
Monitor for iron overload using transferrin saturation >50% and ferritin >800 μg/L as upper safety limits. 2
- True anaphylaxis is very rare with iron sucrose 2
- Most common adverse effects include arthralgia and transient hypotension 6
- Iron sucrose demonstrates better gastrointestinal tolerability compared to oral iron, with only 4.5% discontinuation rate versus 20.8% for oral iron 4
- Approximately 5% of administered iron is eliminated in urine within 24 hours 5
Clinical Context for IV Iron Selection
Iron sucrose is particularly indicated as first-line therapy in:
- Clinically active inflammatory bowel disease 1
- Previous intolerance to oral iron 1
- Hemoglobin below 10 g/dL 1
- Patients requiring erythropoiesis-stimulating agents 1
- Chronic kidney disease with iron deficiency anemia 1
The limitation of iron sucrose is the requirement for multiple infusions (200-300 mg maximum per session), whereas newer formulations like ferric carboxymaltose allow single doses up to 1000 mg. 1, 2 However, iron sucrose has 70 years of clinical experience demonstrating consistent efficacy and safety 7.