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# Iron Sucrose ## Overview Iron sucrose is a parenteral iron complex used to treat iron deficiency anemia in patients who are intolerant to or have failed oral iron therapy. It is administered via intravenous (IV) push or infusion. ## Primary Indications - Iron deficiency anemia in patients with chronic kidney disease (CKD), including those on dialysis and non-dialysis dependent patients receiving erythropoiesis-stimulating agents (ESA). - Treatment of iron deficiency anemia in patients with intolerance or unsatisfactory response to oral iron. ## Adult Dosing Standard institutional protocols vary; however, the typical total cumulative dose is 1,000 mg. - **Hemodialysis-dependent CKD:** 100 mg administered IV push or infusion over 2–5 minutes during 10 consecutive dialysis sessions (total 1,000 mg). - **Non-dialysis dependent CKD:** 200 mg administered IV infusion over 2–5 minutes on 5 different occasions within a 14-day period. - **Non-CKD (oral intolerance):** 200 mg IV infusion repeated 5 times within 14 days. ## Pediatric Dosing *Safety and efficacy in pediatric patients < 2 years have not been established.* - **CKD (Dialysis or Non-dialysis):** 0.5 mg/kg administered at 1–2 week intervals per physician-specific protocol. Maximum single dose: 100 mg. ## Dose Adjustments - **Hepatic Impairment:** No specific adjustment; monitor iron indices closely. - **Renal Impairment:** Dosing is indicated for CKD patients; no further renal adjustment required. - **Older Adults:** Use caution and initiate at the lower end of the dosing range due to potential for greater sensitivity. ## Contraindications - Known hypersensitivity to iron sucrose or any component of the product. - Evidence of iron overload (hemochromatosis, hemosiderosis). - Anemia not caused by iron deficiency. ## Adverse Effects - **Common:** Hypotension, nausea, muscle cramps, injection site reactions (extravasation can cause brown discoloration), and headache. - **Serious:** Anaphylactoid/hypersensitivity reactions (can occur even with prior negative test doses), iron overload, and arrhythmias. ## Key Drug Interactions - **Oral Iron:** Parenteral iron therapy must be held until oral iron preparations are discontinued, as concurrent use may lead to reduced absorption of the oral agent and increased risk of iron overload. ## Monitoring - **Baseline:** Ferritin, transferrin saturation (TSAT), hemoglobin, and hematocrit. - **During Administration:** Monitor blood pressure and pulse for signs of infusion reactions. - **Post-administration:** Re-evaluate iron indices (ferritin/TSAT) at least 48 hours to 1 week after the final dose to avoid falsely elevated results. ## Clinical Pearls - **Administration:** Always flush intravenous lines with 0.9% Normal Saline before and after administration. - **Extravasation:** Avoid extravasation; it may cause persistent brown skin discoloration at the site. - **Hypersensitivity:** While iron sucrose has a lower risk of anaphylaxis compared to iron dextran, all patients should be monitored closely for 30 minutes following administration for signs of hypersensitivity. - **Dose Verification:** Ensure the cumulative dose does not exceed 1,000 mg per treatment course without re-evaluating iron stores. *** **Educational Disclaimer:** This information is for educational purposes only. Clinical settings may utilize specific evidence-based infusion protocols that override general documentation. Always verify current prescribing information, institutional guidelines, and patient-specific factors before administration.