Can Venofer (iron sucrose) 300mg be administered intravenously (IV) on a daily basis?

From the Guidelines

Venofer 300mg IV should not be given daily, as the maximum weekly dose is 500 mg, according to the most recent guidelines 1. The standard administration for adults with iron deficiency anemia is often 200mg given as a slow IV infusion over 30 minutes to 1 hour, with treatments typically spaced out rather than given daily. For hemodialysis patients, the usual dosing is 100mg 1-3 times weekly during dialysis. When administering Venofer, it should be diluted in normal saline (typically 100-250mL) and infused slowly to minimize the risk of adverse reactions such as hypotension, nausea, or hypersensitivity reactions. Some key points to consider when administering Venofer include:

• The maximum single dose is 200 mg 1
• The minimum infusion time for the maximum dose is 30 minutes 1
• Patients should be monitored during and after infusion for signs of adverse reactions
• The total cumulative dose is calculated based on the patient's weight and hemoglobin level, with a typical course of therapy ranging from 1000mg to 1500mg total. Daily administration for multiple consecutive days is not recommended, as it exceeds the maximum weekly dose, and should be determined by a healthcare provider based on the patient's specific iron deficiency status, tolerance to the medication, and clinical response, considering the potential risks of adverse reactions and the availability of alternative dosing regimens 1.

From the FDA Drug Label

1. 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.

No, Venofer 300mg IV should not be given daily, as the recommended dosing regimen for adult patients with PDD-CKD is 2 infusions of 300mg, 14 days apart, followed by a 400mg infusion 14 days later, within a 28-day period 2.

From the Research

Venofer 300mg IV Administration

• The safety and efficacy of intravenous iron sucrose, including Venofer, have been established in various studies 3, 4, 5, 6, 7.
• A study published in 2001 found that 200mg and 300mg doses of IV iron sucrose administered over 2 hours appear to be safe, with no adverse reactions witnessed in patients receiving these doses 4.
• Another study published in 2005 compared the efficacy and safety of intravenous iron sucrose with oral iron sulfate for the treatment of iron deficiency anemia in patients with inflammatory bowel disease, and found that iron sucrose led to a rise in serum ferritin concentrations and had better gastrointestinal tolerability 5.
• A 2023 study found that IV iron sucrose was safe and effective in infants and young children with intestinal failure and iron-deficiency anemia, with a mean increase in hemoglobin of 1.9 ± 0.6 g/dl and no short-term adverse reactions or laboratory abnormalities observed 6.
• A 2004 study examined the safety of iron sucrose for the treatment of iron deficiency and for the maintenance of iron sufficiency in hemodialysis patients, and found that iron sucrose was safe when given as treatment for iron deficiency or for maintenance of iron stores, with no serious or life-threatening drug-related adverse events reported 7.

Daily Administration

• While the studies mentioned above establish the safety and efficacy of IV iron sucrose, including Venofer, they do not specifically address the daily administration of 300mg IV Venofer.
• However, the 2001 study found that 300mg doses of IV iron sucrose administered over 2 hours were safe, suggesting that daily administration of this dose may be feasible 4.
• The 2004 study also found that iron sucrose was safe when given weekly for 10 weeks as a maintenance regimen, which may support the use of daily administration in certain cases 7.