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# Iron sucrose
## Overview
Iron sucrose is a parenteral iron complex used to treat iron deficiency anemia. It provides elemental iron in a non-dextran formulation, minimizing the risk of anaphylaxis compared to high-molecular-weight iron dextran.
## Primary Indications
* Iron deficiency anemia in patients with chronic kidney disease (CKD), including those on dialysis and non-dialysis-dependent patients receiving erythropoietin.
## Adult Dosing
Standard replacement typically requires a cumulative dose of 1,000 mg.
* **Hemodialysis-dependent CKD:** 100 mg IV undiluted push over 2–5 minutes or diluted in 100 mL 0.9% NaCl over 15 minutes, administered during consecutive dialysis sessions (total 10 doses).
* **Non-dialysis-dependent CKD:** 200 mg IV diluted in 100 mL 0.9% NaCl over 15 minutes, administered on 5 different occasions within a 14-day period (total 1,000 mg).
* **Peritoneal dialysis-dependent CKD:** 300 mg IV diluted in 250 mL 0.9% NaCl over 1.5 hours administered at 14-day intervals (total 2 doses), followed by 400 mg IV in 250 mL 0.9% NaCl over 2.5 hours (total 1 dose).
## Pediatric Dosing
* **CKD (Hemodialysis-dependent):** 0.5 mg/kg (max 100 mg/dose) IV every 1–2 weeks for 10 doses.
* **CKD (Non-dialysis-dependent):** 0.5 mg/kg (max 100 mg/dose) IV every 1–2 weeks for 10 doses.
* *Note: Safety and efficacy in children <2 years have not been established; dosing often requires institutional protocol verification.*
## Dose Adjustments
* **Hepatic impairment:** No specific dosage adjustments provided; use with caution.
* **Renal impairment:** Dosing is disease-state specific (outlined above).
## Contraindications
* Known hypersensitivity to iron sucrose or any component of the product.
* Evidence of iron overload (hemochromatosis).
* Anemias not caused by iron deficiency.
## Adverse Effects
* **Common:** Hypotension (during infusion), muscle cramps, nausea, vomiting, injection site reactions, headache, and peripheral edema.
* **Serious:** Anaphylactoid reactions (rare), hypotension, and risk of iron overload.
## Key Drug Interactions
* **Oral Iron:** Parenteral iron should generally not be administered concurrently with oral iron, as absorption of the latter is significantly hindered and serum iron indices may be falsely elevated.
## Monitoring
* **Baseline:** Hemoglobin, hematocrit, serum ferritin, and transferrin saturation (TSAT).
* **During/Post-infusion:** Monitor for signs of hypersensitivity (hypotension, dyspnea, tachycardia) during and for at least 30 minutes after infusion.
* **Long-term:** Repeat iron studies (ferritin and TSAT) at least 48 hours to 1 week following treatment to evaluate response and prevent iron overload.
## Clinical Pearls
* **Hypotension:** Typically related to the rate of administration; slow the infusion rate if hypotension occurs.
* **Compatibility:** Iron sucrose is compatible with 0.9% NaCl only. Do not mix with other medications.
* **Test dose:** Routine test doses are not required by the FDA label, though institutional protocols may vary.
* **Total Body Iron Deficit:** Can be calculated using the Ganzoni formula (Weight [kg] × [Target Hb - Actual Hb] × 0.24 + storage iron) if doses exceeding 1,000 mg are considered non-CKD settings (off-label).
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**Disclaimer:** This information is intended for educational purposes only. Always consult your institution’s specific clinical protocols and the most current FDA-approved prescribing information (package insert) before ordering or administering medication. Dosage calculations should be verified by a licensed pharmacist.
