What is the frequency of administration for intravenous (IV) iron?

From the Guidelines

IV iron can be given as a single dose if the underlying cause of iron deficiency has been eliminated, but for patients with ongoing losses or conditions that inhibit iron absorption, multiple administrations may be necessary, with the frequency depending on the degree of blood loss or malabsorption. The decision on how often to administer IV iron should be guided by laboratory monitoring, including CBC and iron parameters such as ferritin and transferrin saturation (TSAT) levels, which should be evaluated 4 to 8 weeks after the last infusion 1.

Some key points to consider when determining the frequency of IV iron administration include:

• The presence of ongoing blood loss, such as heavy menstrual bleeding or angiodysplasia, which may require more frequent administration 1
• Conditions that inhibit iron absorption, such as celiac disease or autoimmune gastritis, which may also require more frequent administration 1
• The patient's response to treatment, with hemoglobin concentrations expected to increase within 1-2 weeks of treatment and by 1-2 g/dL within 4-8 weeks of therapy 1
• The goal ferritin level, which is 50 ng/mL, regardless of sex at birth, and the use of TSAT and soluble transferrin receptor (sTfR) to evaluate iron status in patients with inflammatory conditions 1

The frequency of laboratory monitoring post-IV iron infusion also depends on the cause of the iron deficiency, with patients with recurrent blood loss requiring more frequent and aggressive monitoring to diagnose and treat iron deficiency even in the absence of anemia 1. Ultimately, the dosing schedule should be individualized based on the patient's specific needs and response to treatment, with the goal of replenishing iron stores and achieving target hemoglobin levels while minimizing the risk of iron overload.

From the FDA Drug Label

2 DOSAGE & ADMINISTRATION Venofer must only be administered intravenously either by slow injection or by infusion.

1. 2 Adult Patients with Hemodialysis Dependent-Chronic Kidney Disease (HDD-CKD) Administer Venofer 100 mg undiluted as a slow intravenous injection over 2 to 5 minutes, or as an infusion of 100 mg diluted in a maximum of 100 mL of 0.9% NaCl over a period of at least 15 minutes, per consecutive hemodialysis session
2. 3 Adult Patients with Non-Dialysis Dependent-Chronic Kidney Disease (NDD-CKD) Administer Venofer 200 mg undiluted as a slow intravenous injection over 2 to 5 minutes or as an infusion of 200 mg in a maximum of 100 mL of 0. 9% NaCl over a period of 15 minutes. Administer on 5 different occasions over a 14 day period.
3. 4 Adult Patients with Peritoneal Dialysis Dependent-Chronic Kidney Disease (PDD-CKD) Administer Venofer in 3 divided doses, given by slow intravenous infusion, within a 28 day period: 2 infusions each of 300 mg over 1.5 hours 14 days apart followed by one 400 mg infusion over 2.5 hours 14 days later. 2.5 Pediatric Patients (2 Years of Age and Older) with HDD-CKD for Iron Maintenance Treatment For iron maintenance treatment: Administer Venofer at a dose of 0.5 mg/kg, not to exceed 100 mg per dose, every two weeks for 12 weeks
4. 6 Pediatric Patients (2 Years of Age and Older) with NDD-CKD or PDD-CKD who are on Erythropoietin Therapy for Iron Maintenance Treatment For iron maintenance treatment: Administer Venofer at a dose of 0.5 mg/kg, not to exceed 100 mg per dose, every four weeks for 12 weeks

The frequency of IV iron administration depends on the patient population and the specific diagnosis.

• Hemodialysis Dependent-Chronic Kidney Disease (HDD-CKD): 100 mg per consecutive hemodialysis session.
• Non-Dialysis Dependent-Chronic Kidney Disease (NDD-CKD): 200 mg on 5 different occasions over a 14 day period.
• Peritoneal Dialysis Dependent-Chronic Kidney Disease (PDD-CKD): 3 divided doses within a 28 day period.
• Pediatric Patients (2 Years of Age and Older) with HDD-CKD: 0.5 mg/kg every two weeks for 12 weeks.
• Pediatric Patients (2 Years of Age and Older) with NDD-CKD or PDD-CKD: 0.5 mg/kg every four weeks for 12 weeks 2.

From the Research

Administration of IV Iron

• IV iron can be administered in various doses, with some studies suggesting that a total cumulative dose of 1000 mg may be insufficient for iron repletion in patients with iron deficiency anemia 3.
• A dose of 1500 mg of IV iron has been shown to be more effective in reducing the need for retreatment compared to a dose of 1000 mg 3.
• IV iron sucrose can be administered in weekly doses of 200 mg until the hemoglobin level is corrected or until the total dose of IV iron calculated for each patient is reached 4.

Frequency of IV Iron Administration

• The frequency of IV iron administration can vary depending on the patient's iron deficit and response to treatment 3, 4.
• Some studies have shown that IV iron can be safely administered in a single setting, with total dose infusion (TDI) offering potential advantages in terms of convenience and efficacy 5.
• However, the optimal frequency and dose of IV iron administration may depend on individual patient factors, such as the severity of iron deficiency and the presence of underlying medical conditions 6, 7.

Safety and Efficacy of IV Iron

• IV iron has been shown to be generally safe and effective in treating iron deficiency anemia, with a low risk of adverse reactions 4, 7.
• However, potential adverse effects of IV iron include skin staining, infusion-related reactions, and hypophosphataemia 6.
• The safety and efficacy of IV iron can vary depending on the specific formulation used, with some studies suggesting that iron sucrose may have a more favorable safety profile compared to other formulations 7.