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# Iron sucrose
## Overview
Iron sucrose is a parenteral iron preparation indicated for iron deficiency anemia. It is a complex of ferric hydroxide and sucrose that allows for controlled release of iron to transferrin and ferritin.
## Primary Indications
* Iron deficiency anemia in patients with chronic kidney disease (CKD) (hemodialysis-dependent, non-dialysis-dependent, and peritoneal dialysis-dependent).
## Adult Dosing
* **Hemodialysis-dependent CKD:** 100 mg administered by slow IV injection or infusion during consecutive dialysis sessions, typically reaching a cumulative dose of 1,000 mg over 10 consecutive sessions.
* **Non-dialysis-dependent CKD:** 200 mg administered by slow IV injection on 5 separate occasions within a 14-day period (total 1,000 mg).
* **Peritoneal dialysis-dependent CKD:** 300 mg via slow IV infusion at weeks 1, 2, and 4 (total 900 mg).
* *Note:* Maintenance dosing may be required based on clinical assessment, typically 100 mg every 2 weeks.
## Pediatric Dosing
* **CKD-related iron deficiency (≥2 years):** 0.5 mg/kg administered by slow IV infusion over 30 minutes at intervals of every 1 to 2 weeks for 5 doses.
* *Maximum single dose:* 100 mg.
## Dose Adjustments
* **Hepatic/Renal Impairment:** No specific adjustment required for renal impairment (dosing is based on the CKD category). Use with caution in patients with severe hepatic dysfunction; iron overload must be avoided.
## 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, nausea, dizziness, leg cramps, headache, and injection site reactions.
* **Serious:** Anaphylaxis and severe hypersensitivity reactions (monitor closely during administration).
## Key Drug Interactions
* **Oral Iron:** Do not administer concurrently. Oral iron absorption is significantly reduced; wait at least 5 days after the last dose of parenteral iron before starting oral supplementation.
## Monitoring
* **During infusion:** Monitor for signs of hypersensitivity (hypotension, dyspnea, tachycardia, rash).
* **Laboratory:** Monitor hemoglobin, hematocrit, serum ferritin, and transferrin saturation (TSAT) to assess response and prevent iron overload.
## Clinical Pearls
* **Administration:** Slow administration is critical to mitigate the risk of hypotension. Refer to specific product labeling for injection rate recommendations.
* **Compatibility:** Compatible with normal saline; do not mix with other medications or add to parenteral nutrition solutions.
* **Uncertainty:** Dosing protocols can vary significantly by clinical setting and local institutional guidelines; always verify the specific regimen against patient weight and iron indices.
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*Disclaimer: This information is for educational purposes only. Clinical guidelines and prescribing protocols vary by institution. Always consult the most current manufacturer prescribing information, institutional protocols, and clinical literature before administering medications.*
