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# Iron sucrose ## Overview Iron sucrose is a parenteral iron complex indicated for the treatment of iron deficiency anemia. It provides replenishing iron stores for patients who cannot tolerate or fail to respond to oral iron. ## Primary Indications * Iron deficiency anemia in patients undergoing chronic hemodialysis (receiving erythropoietin). * Iron deficiency anemia in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD). * Iron deficiency anemia in patients with dialysis-dependent chronic kidney disease (DD-CKD). ## Adult Dosing * **NDD-CKD:** 200 mg slow IV injection or infusion over 2–5 minutes, administered in 5 separate doses over 14 days (Total cumulative dose: 1,000 mg). * **DD-CKD:** 100 mg slow IV injection or infusion during sequential dialysis sessions (usually 10 sessions) for a total cumulative dose of 1,000 mg. May repeat if clinically indicated. * **Peritoneal Dialysis:** 300 mg slow IV infusion over 1.5 hours at weeks 0 and 2, followed by 400 mg at week 4 (Total: 1,000 mg). ## Pediatric Dosing * **DD-CKD (≥2 years):** 0.5 mg/kg (max 100 mg) per dialysis session, up to a total of 1,000 mg over 10 sessions. * **NDD-CKD (≥2 years):** 0.5 mg/kg (max 100 mg) administered 10 times over 8 weeks. * *Note:* Safety and efficacy in children <2 years have not been established. ## Dose Adjustments * **Hepatic Impairment:** No specific manufacturer dosage adjustment; use with caution. * **Renal Impairment:** No secondary dose adjustment required beyond indication-specific protocols. ## Contraindications * Known hypersensitivity to iron sucrose or any of its components. * Evidence of iron overload (hemochromatosis, hemosiderosis). * Anemias not caused by iron deficiency (e.g., hemolytic anemia). ## Adverse Effects * **Common:** Hypotension, nausea, muscle cramps, injection site reactions, headache. * **Serious:** Anaphylaxis/hypersensitivity reactions (monitor closely during administration), iron overload, tachycardia. ## Key Drug Interactions * **Oral Iron:** Parenteral iron may reduce the absorption of oral iron; avoid concomitant oral iron therapy as it may cause iron overload or toxicity. ## Monitoring * **Baseline:** Hemoglobin, hematocrit, serum ferritin, and transferrin saturation (TSAT). * **During/Post-infusion:** Blood pressure and heart rate. * **Long-term:** Monitor ferritin and TSAT levels to avoid iron overload; defer repeat doses if ferritin >500–800 ng/mL or TSAT >30–50%. ## Clinical Pearls * **Administration:** Slow IV administration is critical to avoid hypotension. Can be diluted in 0.9% NaCl (100 mg iron in max 100 mL) to be infused over 15 minutes or given as a slow push. * **Hypersensitivity:** Although rare, life-threatening anaphylaxis can occur. Have resuscitation equipment and medications (epinephrine, antihistamines, corticosteroids) readily available. * **Laboratory Interference:** Serum iron measurements may be elevated for up to 48 hours following administration. *** **Disclaimer:** This information is for educational purposes and reflects general clinical standards. Always consult current institutional protocols and the official manufacturer's prescribing information before ordering or administering medication. Verify patient-specific renal function and laboratory values prior to each dose.