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# Iron Sucrose ## Overview Iron sucrose is a parenteral iron preparation used for intravenous iron replacement. It consists of a polynuclear iron(III)-hydroxide in complex with sucrose. It is intended for slow administration to minimize the risk of hypersensitivity reactions. ## Primary Indications * Iron deficiency anemia (IDA) in patients with chronic kidney disease (CKD), including those on dialysis and non-dialysis dependent. * IDA in patients intolerant to or unresponsive to oral iron. ## Adult Dosing * **Hemodialysis-associated CKD:** 100 mg administered intravenously during consecutive dialysis sessions, up to a total cumulative dose of 1,000 mg over 10 sessions. * **Non-dialysis CKD:** 200 mg intravenously on 5 different occasions within a 14-day period (total 1,000 mg). * **Non-CKD IDA:** 200 mg intravenously on 5 occasions within 14 days OR 500 mg infused over 3.5 to 4 hours on two occasions separated by 14 days. * *Note: Always calculate the iron deficit based on hemoglobin and body weight (Ganzoni formula or institutional protocol).* ## Pediatric Dosing * **Hemodialysis-dependent CKD:** 0.5 mg/kg (max 100 mg) administered over 10 sessions. * **Non-dialysis CKD or IDA:** Dosing is often weight-based; consult institutional protocols or clinical nutrition guidelines, as pediatric dosing is frequently extrapolated and requires specific safety oversight. ## Dose Adjustments * **Hepatic Impairment:** No specific adjustment necessary. * **Renal Impairment:** Dosing is specifically established for renal patients (see Adult Dosing); no further adjustment required, but monitor iron status closely. * **Elderly:** Use caution and initiate at the lower end of the dosing range due to potential for decreased hepatic/renal function. ## Contraindications * Known hypersensitivity to iron sucrose or any of its components. * Evidence of iron overload (hemochromatosis, hemosiderosis). * Anemias not caused by iron deficiency (e.g., hemolytic anemia). ## Adverse Effects * **Common:** Hypotension, nausea, injection site reactions (extravasation can cause brown discoloration), and muscle cramps. * **Serious:** Anaphylaxis or hypersensitivity reactions (may include flushing, dyspnea, and back/chest pain). ## Key Drug Interactions * **Oral Iron:** Parenteral iron therapy must be held until oral iron supplementation is discontinued, as concomitant use leads to high levels of serum iron. * **ACE Inhibitors:** May increase the risk of hypersensitivity reactions. ## Monitoring * **Baseline:** Serum ferritin, transferrin saturation (TSAT), and hemoglobin. * **During Infusion:** Monitor blood pressure and pulse during and immediately after administration. Observe for signs of anaphylaxis for at least 30 minutes after completion. * **Post-Treatment:** Reassess iron indices (ferritin/TSAT) 2–4 weeks after the final dose to assess response and prevent iron overload. ## Clinical Pearls * **Administration:** Iron sucrose must be diluted in 0.9% Normal Saline prior to IV push or infusion. Rapid administration significantly increases the risk of hypotension. * **Hypersensitivity:** While Iron Sucrose has a lower rate of anaphylaxis compared to Iron Dextran, a test dose is *not* routinely required but clinicians must be prepared to manage severe allergic reactions. * **Compatibility:** Do not mix with other medications or add to parenteral nutrition solutions. *** *Disclaimer: This information is for educational purposes and is not a substitute for professional clinical judgment. Dosing and administration protocols may vary by institution. Always verify current prescribing information, institutional guidelines, and weight-based calculations before prescribing or administering medication.*