What dose of Venofer (iron sucrose) intravenous (IV) should be prescribed for a patient with iron deficiency anemia?

From the Guidelines

For iron deficiency anemia, Venofer (iron sucrose) should be prescribed at a dose of 200 mg administered intravenously over 2-5 minutes, given 1-3 times weekly until the desired total dose is reached, as recommended by the most recent guidelines 1. The total dose can be calculated using the Ganzoni formula: Total iron deficit (mg) = [target Hb - actual Hb] × weight (kg) × 0.24 + 500 mg (for iron stores). Some key points to consider when prescribing Venofer include:

• The maximum single dose is 200 mg, and the maximum weekly dose is 500 mg, as indicated in the study 1.
• The minimum infusion time for the maximum dose is 2-5 minutes, according to the FDA guidelines mentioned in the study 1.
• Before initiating treatment, it is essential to confirm iron deficiency with laboratory tests (ferritin, transferrin saturation).
• Monitor for potential adverse reactions during administration, including hypotension, nausea, and hypersensitivity reactions.
• A test dose is not required for Venofer, unlike some other IV iron preparations.
• Venofer is preferred in patients with chronic kidney disease but is effective for various causes of iron deficiency.
• Reassess hemoglobin and iron parameters 4-8 weeks after completing the course to evaluate response to therapy. The study 1 provides the most recent and highest quality evidence for the use of Venofer in treating iron deficiency anemia, and its recommendations should be followed to ensure the best possible outcomes for patients.

From the FDA Drug Label

2 DOSAGE & ADMINISTRATION Venofer must only be administered intravenously either by slow injection or by infusion. The dosage of Venofer is expressed in mg of elemental iron. Each mL contains 20 mg of elemental iron.

1. 1 Mode of Administration Administer Venofer only intravenously by slow injection or by infusion. The dosage of Venofer is expressed in mg of elemental iron. Each mL contains 20 mg of elemental iron.

2. 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 [see How Supplied/Storage and Handling ( 16.2).] Administer Venofer early during the dialysis session (generally within the first hour). The usual total treatment course of Venofer is 1000 mg. Venofer treatment may be repeated if iron deficiency reoccurs.

3. 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.

The recommended dosage of Venofer for adult patients with iron deficiency anemia is:

• For HDD-CKD patients: 100 mg per consecutive hemodialysis session, with a total treatment course of 1000 mg.
• For NDD-CKD patients: 200 mg on 5 different occasions over a 14 day period. No specific dosage is provided for patients with iron deficiency anemia without CKD. 2

From the Research

Venofer IV Dosing for Iron Deficiency Anemia

• The dosing of Venofer IV (iron sucrose) for patients with iron deficiency anemia can vary based on the individual's iron deficit and response to treatment 3, 4.
• A study published in 2015 suggested that a total cumulative dose of 1000 mg of IV iron may be insufficient for iron repletion in a majority of patients with IDA, and a dose of 1500 mg is closer to the actual iron deficit in these patients 3.
• Another study from 2011 found that intravenous iron sucrose was effective in treating adults with iron deficiency anemia, with a weekly dose of 200 mg until the hemoglobin level was corrected or until receiving the total dose of intravenous iron calculated for each patient 4.
• The dosage and administration of Venofer IV should be individualized based on the patient's iron deficit, which can be calculated using a modified Ganzoni formula 3.
• Studies have shown that iron sucrose is a safe and effective option for treating iron deficiency anemia in patients who lack a satisfactory response to oral iron therapy, with a clinically manageable safety profile when using appropriate dosing and monitoring 4, 5, 6.
• A 2021 study found that iron sucrose injection can significantly increase the hemoglobin concentration in anemia patients with serum iron concentration below the lower limit of the normal range 7.

Key Considerations

• The average iron deficit in patients with iron deficiency anemia was calculated to be around 1392-1531 mg 3.
• A cumulative dose of 1500 mg of IV iron may be more effective in achieving iron repletion than a dose of 1000 mg 3.
• Intravenous iron sucrose has been shown to be well-tolerated and effective in a wide range of patient populations, including those with chronic kidney disease, inflammatory bowel disease, and cancer 5, 6.