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# Iron sucrose ## Overview Iron sucrose is a parenteral iron complex used for intravenous iron replacement. It consists of iron(III)-hydroxide in complex with sucrose, which is dissociated by the reticuloendothelial system to release iron for erythropoiesis. ## Primary Indications Treatment of iron-deficiency anemia in patients undergoing chronic hemodialysis, non-dialysis dependent chronic kidney disease (NDD-CKD), and peritoneal dialysis-dependent patients. ## Adult Dosing * **Hemodialysis-dependent (HDD-CKD):** 100 mg administered intravenously (IV) during sequential dialysis sessions for a total cumulative dose of 1,000 mg over 10 sessions. * **Non-dialysis dependent (NDD-CKD):** 200 mg IV administered over 2 to 5 minutes on 5 different occasions within a 14-day period. Total cumulative dose: 1,000 mg. * **Peritoneal dialysis-dependent (PD-CKD):** 300 mg IV infusion over 1.5 hours at weeks 1, 3, and 5 (total 900 mg). * *Note:* Dosing varies by institution and clinical protocol. Always verify total iron deficit calculations (Ganzoni formula) if required by local guidelines. ## Pediatric Dosing * **HDD-CKD:** 0.5 mg/kg (max 100 mg) every dialysis session, not to exceed 100 mg/dose for up to 10 sessions (cumulative max 1,000 mg). * **NDD-CKD or PD-CKD:** 0.5 mg/kg (max 100 mg) every 2 weeks for 5 doses (cumulative max 500 mg). * *Safety Note:* Pediatric dosing is less established than adult dosing; confirm protocol with institutional pediatric specialists. ## Dose Adjustments * **Hepatic Impairment:** No specific adjustment manufacturer-defined, but caution is advised. * **Renal Impairment:** Dosing is specific to CKD status (see above). * **Hypersensitivity:** If a reaction occurs, stop infusion immediately. ## Contraindications * Known hypersensitivity to iron sucrose or any of its components. * Evidence of iron overload (hemochromatosis, hemosiderosis). * Anemias not associated with iron deficiency. ## Adverse Effects * **Common:** Hypotension, muscle cramps, nausea, diarrhea, and headache. * **Serious:** Anaphylaxis and other hypersensitivity reactions (may include flushing, dyspnea, and tachycardia). * **Infusion-related:** Arthralgia and back pain may occur if infused too rapidly. ## Key Drug Interactions * **Oral Iron:** Parenteral iron may decrease the absorption of concomitant oral iron preparations. Avoid concurrent administration. * **Laboratory Interference:** May cause falsely elevated serum iron and ferritin levels for up to 2 weeks post-administration. ## Monitoring * **Anaphylaxis:** Monitor closely for signs/symptoms during and for at least 30 minutes after infusion. * **BP:** Monitor blood pressure during administration. * **Iron Status:** Periodic assessment of hemoglobin, hematocrit, serum ferritin, and transferrin saturation (TSAT) to guide therapy and prevent iron overload. ## Clinical Pearls * **Administration:** May be administered via slow IV push (over 2–5 minutes) or diluted for IV infusion. Rapid administration can cause hypotension or "flush" syndrome. * **Compatibility:** Compatible with 0.9% Normal Saline only. Do not mix with other medications or parenteral nutrition. * **Test Dose:** While not universally required by the package insert, some clinicians prefer a test dose in patients with a history of drug allergies. * **Calculation:** Ensure iron therapy is indicated by labs (low TSAT and low ferritin) to avoid toxicity. *** **Disclaimer:** This information is for educational purposes and does not replace professional clinical judgment. Always verify current prescribing information, institutional protocols, and patient-specific contraindications before administering medication.