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# Iron Sucrose ## Overview Iron sucrose is an intravenous iron preparation used to treat iron deficiency anemia. It is a complex of polynuclear iron(III)-hydroxide in sucrose. It provides supplemental iron for the storage of iron in ferritin and the synthesis of hemoglobin. ## Primary Indications * Iron deficiency anemia in patients with chronic kidney disease (CKD), including those on dialysis (hemodialysis or peritoneal) and non-dialysis dependent. * Iron deficiency anemia in patients who are intolerant to or have failed oral iron. ## Adult Dosing * **Hemodialysis-dependent CKD:** 100 mg administered intravenously as a slow injection or infusion during each consecutive hemodialysis session to a total cumulative dose of 1,000 mg over 10 sessions. * **Non-dialysis dependent CKD:** 200 mg intravenously in 5 doses administered over 14 days (total 1,000 mg). * **Peritoneal dialysis-dependent CKD:** 300 mg intravenously in 2 doses separated by 14 days, followed by 400 mg once 14 days later (total 1,000 mg). * **Iron deficiency anemia (general/non-CKD):** Standard protocols often utilize 200 mg intravenous infusions over 2–5 minutes or diluted in 100 mL of 0.9% NaCl over 15 minutes, repeated up to a cumulative dose of 1,000 mg (frequency may vary by center). ## Pediatric Dosing * **CKD (Hemodialysis-dependent):** 0.5 mg/kg administered during each dialysis session (maximum 100 mg per dose) for 10 sessions (cumulative dose not to exceed 1,000 mg). * **CKD (Non-dialysis dependent):** 0.5 mg/kg administered once every 2 weeks for 5 doses (maximum 100 mg per dose). * *Note: Dosing should be individualized; consult hospital-specific protocols for pediatric off-label use.* ## Dose Adjustments * **Hepatic Impairment:** No specific adjustment defined, but use with caution. * **Renal Impairment:** Dosing is specific to the dialysis status/CKD stage as outlined above; follow facility-specific iron replacement protocols. ## Contraindications * Known hypersensitivity to iron sucrose or any of its components. * Evidence of iron overload (hemochromatosis). * Anemias not caused by iron deficiency. ## Adverse Effects * **Common:** Hypotension, nausea, muscle cramps, injection site reactions, and headache. * **Serious:** Anaphylactoid reactions (hypersensitivity), including monitoring for rash, wheezing, and circulatory collapse. Iron overload with chronic/excessive use. ## Key Drug Interactions * **Oral Iron:** Do not administer oral iron concomitantly as it may decrease the absorption of oral iron therapy. Delay oral iron initiation until at least 5 days after the last iron sucrose dose. ## Monitoring * **Baseline:** Hemoglobin, hematocrit, serum ferritin, and transferrin saturation (TSAT). * **During Infusion:** Monitor for signs of hypersensitivity (hypotension, flushing, dyspnea) during and for at least 30 minutes following administration. * **Long-term:** Repeat ferritin and TSAT levels to avoid iron overload; do not administer if ferritin >500–800 ng/mL (threshold varies by institution). ## Clinical Pearls * **Rate of Administration:** Rapid administration may cause hypotension, flushing, or tachycardia. Follow recommended infusion times strictly. * **Extravasation:** Avoid extravasation; it may cause brown skin discoloration and local irritation. * **Safety:** Unlike older high-molecular-weight iron dextran, iron sucrose has a lower risk of severe anaphylaxis, but all necessary equipment for cardiopulmonary resuscitation must be available. * **Dosing Calculation:** Total iron deficit (mg) = Weight (kg) × (Target Hb - Actual Hb) × 0.24 + Iron stores (usually 500 mg). Many clinical protocols use standard 1,000 mg replacement to simplify administration. *** **Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Always verify current prescribing information, institutional protocols, and patient-specific factors before administering any medication.