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# Iron sucrose
## Overview
Iron sucrose is a parenteral iron complex used to replenish body iron stores in patients with iron deficiency anemia. Unlike iron dextran, it does not require a test dose, though administration must be monitored for hypersensitivity.
## Primary Indications
* Iron deficiency anemia in patients with chronic kidney disease (CKD), including those on dialysis or non-dialysis dependent.
* Iron deficiency anemia in patients intolerant to or unresponsive to oral iron.
## Adult Dosing
* **Hemodialysis-dependent CKD:** 100 mg administered intravenously as a slow injection or infusion during sequential dialysis sessions for a total cumulative dose of 1,000 mg over 10 sessions.
* **Non-dialysis dependent CKD:** 200 mg intravenously as a slow injection on 5 different occasions within a 14-day period (total 1,000 mg).
* **Peritoneal dialysis-dependent CKD:** 300 mg as an infusion over 1.5 hours in 2 doses, followed by 400 mg in 1 dose (total 1,000 mg) over 14 days.
* **Non-CKD IDA:** 200 mg intravenously on 5 occasions over 14 days (total 1,000 mg).
## Pediatric Dosing
* **CKD-related IDA (Ages 2 years and older):** 0.5 mg/kg (max 100 mg) per dose administered via slow IV injection or infusion. Dosing frequency and cumulative dose depend on specific clinical protocol and hemoglobin targets. Consult pediatric nephrology guidelines.
## Dose Adjustments
* **Hepatic Impairment:** No formal adjustments, but monitor for iron overload.
* **Renal Impairment:** Dosing is weight/indication-based (see above).
* **General:** Hold if serum ferritin exceeds 800 ng/mL or transferrin saturation (TSAT) exceeds 40%.
## Contraindications
* Known hypersensitivity to iron sucrose or any component of the product.
* Evidence of iron overload (hemochromatosis).
* Anemias not associated with iron deficiency.
## Adverse Effects
* **Common:** Hypotension (often related to rate of administration), muscle cramps, nausea, vomiting, dizziness/headache, and injection site reactions (extravasation may cause brown discoloration).
* **Serious:** Anaphylaxis or hypersensitivity reactions, iron toxicity, and hypertension.
## Key Drug Interactions
* **Oral Iron:** Parenteral iron may decrease the absorption and efficacy of oral iron preparations. Avoid concurrent administration.
* **Dimercaprol:** Should not be used concomitantly due to the formation of toxic complexes.
## Monitoring
* **Baseline:** Hemoglobin, hematocrit, serum ferritin, and TSAT.
* **During infusion:** Blood pressure and heart rate must be monitored throughout administration, especially in hemodialysis patients. Observe for signs of hypersensitivity (flushing, chest pain, dyspnea).
* **Follow-up:** Re-evaluate hematologic parameters 2–4 weeks after the final dose to assess response.
## Clinical Pearls
* **Infusion Rate:** Rapid administration can precipitate hypotension. Adhere strictly to manufacturer-recommended infusion times.
* **Compatibility:** Compatible only with 0.9% Normal Saline. Do not mix with other medications or parenteral nutrition.
* **Stability:** If diluted, the solution is stable for 7 days at room temperature.
* **Extravasation:** Requires extreme caution; can lead to long-lasting skin staining.
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*Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Dosing protocols may vary by institution. Always verify dosages and compatibility against the current package insert and your facility's prescribing guidelines before administration.*
