Iron%252520sucrose

# Iron sucrose ## Overview Iron sucrose is an intravenous iron complex used to replenish iron stores in patients with iron deficiency anemia (IDA) who are intolerant or unresponsive to oral iron. It replaces iron lost through hemodialysis or chronic blood loss. ## Primary Indications * Iron deficiency anemia in patients undergoing chronic hemodialysis (CKD-HD). * Iron deficiency anemia in non-dialysis dependent chronic kidney disease (NDD-CKD). * Iron deficiency anemia in peritoneal dialysis-dependent chronic kidney disease (PD-CKD). ## Adult Dosing * **Hemodialysis (CKD-HD):** 100 mg administered intravenously as a slow injection or infusion during consecutive dialysis sessions. Usual cumulative dose to achieve target hemoglobin/ferritin: 1,000 mg over 10 consecutive dialysis sessions. * **Non-Dialysis (NDD-CKD):** 200 mg slow intravenous injection over 2–5 minutes, repeated on 5 different occasions within a 14-day period. Cumulative dose: 1,000 mg. * **Peritoneal Dialysis (PD-CKD):** 300 mg via slow IV infusion over 1.5 hours at weeks 1, 3, and 5 (total 900 mg). * *Note: Dosing often follows institution-specific protocols based on calculated iron deficits (Ganzoni formula).* ## Pediatric Dosing * **CKD-HD:** 0.5 mg/kg administered during each dialysis session (maximum 100 mg per dose) up to a cumulative dose of 1,000 mg over 10 sessions. * **NDD-CKD:** 0.5 mg/kg (maximum 100 mg) administered at 1–2 week intervals for 5 doses. * *Consult institutional protocols as pediatric dosing is highly individualized based on age, weight, and clinical status.* ## Dose Adjustments * **Hepatic Impairment:** No specific adjustment required; use with caution. * **Renal Impairment:** Dosing provided above is specific for CKD subsets. Re-evaluate serum ferritin and transferrin saturation (TSAT) before exceeding cumulative 1,000 mg limit. ## Contraindications * Hypersensitivity to iron sucrose or any component of the formulation. * Evidence of iron overload (hemochromatosis). * Anemias not associated with iron deficiency. ## Adverse Effects * **Common:** Hypotension (often dose/infusion rate-related), muscle cramps, nausea, diarrhea, headache, peripheral edema, and infusion site reactions. * **Severe:** Anaphylactic-type reactions (rare), hypotension, and potential for iron overload if over-supplemented. ## Key Drug Interactions * **Oral Iron:** Do not administer concurrently; oral iron absorption is significantly reduced and generally ineffective when patients are receiving IV iron. * **Dimercaprol:** Avoid concurrent use; may form toxic complexes with iron. ## Monitoring * **During Infusion:** Monitor blood pressure and pulse during and immediately after administration. * **Laboratory:** Ferritin and Transferrin Saturation (TSAT) are essential. Monitor Hb, Hct, Ferritin, and TSAT periodically to assess response and prevent iron overload. * **Iron Overload:** Avoid supplementation if serum ferritin >800 ng/mL or TSAT >50%. ## Clinical Pearls * **Administration:** Can be given as a slow IV push (undiluted) or as a diluted IV infusion. Infusion is generally better tolerated than rapid undiluted push. * **Hypotension:** If hypotension occurs during administration, slow the infusion rate or discontinue, then provide supportive care. * **Safety:** Ensure the patient is not currently suffering from an acute infection, as IV iron may exacerbate bacterial growth. * **Calculations:** Many centers utilize the Ganzoni formula to calculate total iron needs based on hemoglobin levels and patient weight. *** **Educational Disclaimer:** This information is for educational purposes only. Always consult the latest manufacturer prescribing information, institutional protocols, and clinical guidelines before prescribing or administering medication.