Iron%25252520sucrose

# Iron Sucrose ## Overview Iron sucrose is a parenteral iron complex used to replenish iron stores in patients with iron deficiency anemia. It is formulated as an aqueous complex of iron(III)-hydroxide in sucrose, requiring intravenous administration. ## Primary Indications * Iron deficiency anemia in patients undergoing chronic hemodialysis (receiving erythropoietin). * Iron deficiency anemia in patients with non-dialysis dependent chronic kidney disease (NDD-CKD). * Iron deficiency anemia in patients with dialysis-dependent chronic kidney disease (DD-CKD). ## Adult Dosing * **Hemodialysis (DD-CKD):** 100 mg IV slowly over 2–5 minutes (or infused over 15 minutes) during consecutive dialysis sessions. Typical total cumulative dose is 1,000 mg over 10 doses. * **Non-Dialysis CKD:** 200 mg IV administered on 5 separate occasions over 14 days (total 1,000 mg cumulative dose). * **Peritoneal Dialysis:** 300 mg IV followed by 300 mg 14 days later, then 400 mg 14 days after that (total 1,000 mg). * *Note:* Dosing schedules may vary by local institutional protocol. ## Pediatric Dosing * **Hemodialysis (Ages 2 years and older):** 0.5 mg/kg (max 100 mg/dose) IV every 2 weeks for 12 sessions. * **Non-Dialysis CKD (Ages 2 years and older):** 0.5 mg/kg (max 100 mg/dose) IV every 2 weeks for 12 sessions. ## Dose Adjustments * **Hepatic Impairment:** No official adjustment, but use caution in patients with liver dysfunction as iron overload is a risk. * **Renal Impairment:** Dosing is intrinsic to CKD management; however, assess baseline ferritin, transferrin saturation (TSAT), and hemoglobin prior to administration. ## Contraindications * Known hypersensitivity to iron sucrose or any component of the product. * Evidence of iron overload (hemochromatosis). * Anemia not caused by iron deficiency. ## Adverse Effects * **Common:** Hypotension, muscle cramps, nausea, vomiting, injection site reactions, and headache. * **Serious:** Anaphylaxis and other hypersensitivity reactions (monitor closely during and for 30 minutes after infusion). ## Key Drug Interactions * **Oral Iron:** Parenteral iron may decrease the absorption or efficacy of concurrently administered oral iron preparations; avoid oral iron therapy until at least 5 days after the final IV dose. ## Monitoring * **Pre-administration:** Hemoglobin, hematocrit, serum ferritin, and TSAT. * **During:** Pulse, blood pressure (hypotension risk), and infusion site for extravasation. * **Post-administration:** Monitor for delayed hypersensitivity reactions. Avoid rapid administration to prevent hypotension. ## Clinical Pearls * **Extravasation:** Avoid extravasation; iron can cause brown discoloration and local tissue irritation at the injection site. * **Test Dose:** While not universally required by the package insert for every patient, clinical judgment should be used for patients with high allergy risk. * **Efficacy:** Effectiveness is best monitored by checking reticulocyte count (7–10 days) and ferritin/Hgb levels (4 weeks post-treatment). *** **Educational Disclaimer:** This information is for educational purposes only. Always verify drug dosages, contraindications, and compatibility against current local institutional protocols and the manufacturer’s latest prescribing information (package insert) before ordering or administering medication.