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# Iron Sucrose
## Overview
Iron sucrose is an intravenous iron preparation used to replenish body iron stores in patients with iron deficiency anemia. It is a complex of polynuclear iron(III)-hydroxide in sucrose.
## Primary Indications
* Iron deficiency anemia in patients undergoing chronic hemodialysis (CKD 5/5D).
* Iron deficiency anemia in patients with non-dialysis dependent chronic kidney disease (CKD).
* Iron deficiency anemia in patients with nephropathy.
## Adult Dosing
* **Hemodialysis-dependent CKD:** 100 mg administered intravenously during consecutive dialysis sessions for a total cumulative dose of 1,000 mg over 10 sessions.
* **Non-dialysis dependent CKD:** 200 mg administered by slow intravenous injection (2–5 minutes) on 5 different occasions within a 14-day period (total 1,000 mg).
* **Peritoneal dialysis-dependent CKD:** 300 mg via slow IV infusion over 1.5 hours at weeks 0, 2, and 4 (total 900 mg).
*Note: Dosing regimens vary by institutional protocol and patient iron deficit calculation (Ganzoni formula).*
## Pediatric Dosing
* **Hemodialysis-dependent CKD:** 0.5 mg/kg (max 100 mg) administered intravenously during consecutive dialysis sessions, not to exceed a total cumulative dose of 1000 mg over 10 sessions.
* **Non-dialysis dependent CKD:** 0.5 mg/kg (max 100 mg) administered intravenously every 1–2 weeks for 5 doses (total 500 mg).
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific adjustment required beyond established CKD protocols.
* **Hypersensitivity:** If a reaction occurs, discontinue immediately and treat symptomatically.
## Contraindications
* Known hypersensitivity to iron sucrose or any of its components.
* Evidence of iron overload (hemochromatosis).
* Anemias not caused by iron deficiency (e.g., hemolytic anemia).
## Adverse Effects
* **Common:** Hypotension, nausea, muscle cramps, injection site reactions, headache.
* **Serious:** Anaphylaxis/anaphylactoid reactions (rare but potentially fatal).
## Key Drug Interactions
* **Oral Iron:** Do not administer oral iron concurrently; it significantly reduces the absorption/efficacy of oral iron supplements. Wait at least 5 days after the last dose of IV iron to initiate oral therapy.
## Monitoring
* **Laboratory:** Monitor hemoglobin, hematocrit, serum ferritin, and transferrin saturation (TSAT) to assess response and avoid over-repletion.
* **Clinical:** Observe patient for at least 30 minutes following administration for signs of hypersensitivity (hypotension, dyspnea, rash).
## Clinical Pearls
* **Administration:** May be administered by slow IV push (dilution not required if 100 mg/2–5 min) or IV infusion (diluted in 0.9% NaCl). Consult package insert for infusion concentration limits (typically 100 mg per 100 mL).
* **Iron Overload:** Avoid over-repletion; iron sucrose does not contribute to the erythropoietic stimulating agent (ESA) effect but is required for ESA efficacy.
* **Efficacy:** If hemoglobin does not increase after appropriate dosing, investigate other causes of anemia (e.g., occult blood loss, B12/folate deficiency).
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**Disclaimer:** This information is for educational purposes only. Always verify doses, contraindications, and administration protocols against the manufacturer’s current prescribing information (package insert) and your institution’s clinical guidelines before prescribing or administering medication.
