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# Iron sucrose ## Overview Iron sucrose is an intravenous iron preparation containing ferric hydroxide in complex with sucrose. It is used to replenish total body iron stores in patients with iron deficiency anemia (IDA) who are intolerant or unresponsive to oral iron. ## Primary Indications * Iron deficiency anemia in patients with chronic kidney disease (CKD), including those on dialysis and non-dialysis dependent CKD. * Off-label: Iron deficiency anemia in patients with inflammatory bowel disease or other intolerance to oral iron. ## Adult Dosing Must be administered via slow IV injection or infusion. Total dose is typically 1,000 mg cumulative. * **Hemodialysis-dependent CKD:** 100 mg administered during concurrent dialysis sessions (up to 1,000 mg cumulative over 10 sessions). * **Non-dialysis CKD:** 200 mg slow IV injection over 2–5 minutes on 5 separate occasions within 14 days (1,000 mg cumulative). * **Peritoneal dialysis-dependent CKD:** 300 mg slow IV infusion over 1.5 hours on 2 occasions, followed by 400 mg over 2.5 hours on 1 occasion (1,000 mg cumulative). *Note: Dosing regimens vary significantly by local institutional protocol and patient weight/hemoglobin targets. Always verify specific institutional guidelines.* ## Pediatric Dosing Established for use in pediatric patients (ages 2 years and older) with CKD-related IDA. * **Hemodialysis-dependent:** 0.5 mg/kg (max 100 mg) per dialysis session, up to a cumulative dose of 1,000 mg over 10 sessions. * **Non-dialysis dependent:** 0.5 mg/kg (max 100 mg) every 2 weeks for 5 doses (cumulative 1,000 mg). ## Dose Adjustments * **Hepatic Impairment:** No specific adjustment, but use with caution due to risk of iron overload. * **Renal Impairment:** Dosing is specific to the dialysis status; no adjustment for creatinine clearance is required beyond established protocols. ## Contraindications * Known hypersensitivity to iron sucrose or any component of the complex. * Anemia not caused by iron deficiency. * Evidence of iron overload (hemochromatosis) or disorders of iron utilization (sideroblastic anemia). ## Adverse Effects * **Common:** Hypotension, muscle cramps, nausea, injection site reactions, headache. * **Serious:** Anaphylaxis and severe hypersensitivity reactions (monitor closely during and after infusion), arrhythmias, and iron overload (hemosiderosis). ## Key Drug Interactions * **Oral Iron:** Do not administer oral iron concurrently; IV iron preparations significantly decrease absorption and may cause additive iron toxicity. Wait at least 5 days after the last IV iron dose before initiating oral iron. * **ACE Inhibitors:** May increase the risk of systemic anaphylactoid-type reactions to IV iron. ## Monitoring * **During/Post-infusion:** Blood pressure and heart rate; monitor for signs of anaphylaxis for at least 30 minutes post-dose. * **Laboratory:** Serum ferritin, transferrin saturation (TSAT), and hemoglobin at baseline and periodically during therapy. * **Avoid:** Do not treat if TSAT >50% or ferritin >800 ng/mL, as this indicates potential iron overload. ## Clinical Pearls * **Administration:** Can be given as a slow IV push (undiluted) or diluted in 0.9% Normal Saline. Never mix with other medications. * **Extravasation:** High risk of brown skin discoloration; monitor the injection site carefully. * **Repletion:** Full efficacy on hemoglobin levels should be assessed 4–8 weeks after therapy completion. * **Hypersensitivity:** Unlike iron dextran, iron sucrose does not require a formal test dose, but vigilance is still required for infusion reactions. *** *Disclaimer: This information is for educational purposes only. Always consult the most current product labeling (FDA/EMA), institutional guidelines, and pharmacy resources before prescribing or administering medications.*