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# Iron sucrose ## Overview Iron sucrose is a parenteral iron complex used to treat iron deficiency anemia. It is designed for intravenous administration to replenish body iron stores when oral therapy is ineffective, poorly tolerated, or rapid replenishment is required. ## Primary Indications * Iron deficiency anemia in patients with chronic kidney disease (CKD), including those on dialysis and non-dialysis dependent. * Treatment of iron deficiency anemia in patients who are intolerant to or have had an unsatisfactory response to oral iron. ## Adult Dosing * **Hemodialysis-dependent CKD:** 100 mg intravenously (IV) administered 1–3 times per week to a cumulative dose of 1,000 mg over 10 sessions. * **Non-dialysis dependent CKD:** 200 mg IV over 2–5 minutes administered on 5 different occasions within a 14-day period (total cumulative dose 1,000 mg). * **General Iron Deficiency Anemia (Non-CKD):** 200 mg IV administered on 5 separate occasions within a 14-day period. Alternatively, some protocols utilize 500 mg infused over 3.5 to 4 hours, repeated once 14 days later. * *Note: Always consult local institutional protocols for specific infusion rates and cumulative dosing calculations (e.g., Ganzoni formula).* ## Pediatric Dosing * **Hemodialysis-dependent CKD:** 0.5 mg/kg IV administered during the dialysis session, not to exceed 100 mg per dose, 1–3 times per week. (Safety and efficacy in children <2 years have not been established). * **Non-dialysis dependent CKD:** 0.5 mg/kg IV once every two weeks for 5 doses (max 100 mg/dose). ## Dose Adjustments * **Renal Impairment:** Dosing provided above is specific to CKD and dialysis patients. * **Hepatic Impairment:** No specific adjustment required; however, use with caution due to the risk of iron overload. ## Contraindications * Known hypersensitivity to iron sucrose or any of its components. * Anemia not caused by iron deficiency. * Evidence of iron overload (hemochromatosis) or disturbances in iron utilization. * First trimester of pregnancy (relative contraindication; use only if benefit outweighs risk). ## Adverse Effects * **Common:** Hypotension, nausea, muscle cramps, injection site reactions, headache. * **Serious:** Anaphylaxis and hypersensitivity reactions (may include flushing, dyspnea, tachycardia, or cardiovascular collapse). ## Key Drug Interactions * **Oral Iron:** Parenteral iron should not be administered concurrently with oral iron preparations; oral iron absorption is significantly reduced and should be delayed until 5 days after the final IV dose. ## Monitoring * **During Infusion:** Monitor blood pressure, pulse, and oxygen saturation. Observe patients for at least 30 minutes following injection for delayed hypersensitivity. * **Laboratory:** Monitor hemoglobin, hematocrit, serum ferritin, and transferrin saturation (TSAT) to assess response and prevent iron overload. ## Clinical Pearls * **Administration:** May be given as a slow IV push or diluted in 0.9% Normal Saline for infusion. Never administer undiluted as a rapid bolus. * **Safety:** Hypersensitivity reactions can occur even in patients with no prior history of reaction. Have resuscitation equipment and personnel immediately available. * **Stability:** If diluted, the solution is typically stable for up to 7 days at room temperature or refrigerated. *** **Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines and local institutional protocols vary significantly. Always verify the most current prescribing information through official FDA labels (e.g., DailyMed) and consult your local pharmacy and therapeutics committee before administration.