Please check your internet connection and try again.
# Iron Sucrose
## Overview
Iron sucrose is an intravenous iron preparation indicated for iron-deficiency anemia. It is a complex of polynuclear iron(III)-hydroxide in sucrose for parenteral administration. It is less immunogenic than high-molecular-weight iron dextran.
## 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 NDD-CKD receiving erythropoietin.
## Adult Dosing
* **Hemodialysis-dependent CKD:** 100 mg administered either by slow IV push (over 2–5 minutes) or infusion (over 15–30 minutes) per dialysis session, up to a cumulative dose of 1,000 mg over 10 sessions.
* **Non-Dialysis CKD:** 200 mg slow IV injection (over 2–5 minutes) or infusion (over 15 minutes) on 5 occasions within a 14-day period (total 1,000 mg).
* **General Protocol Note:** Total dose requirements are often calculated using the Ganzoni formula; however, local protocols for cumulative dose titration vary significantly based on patient weight and hemoglobin deficits.
## Pediatric Dosing
* **Hemodialysis-dependent CKD:** 0.5 mg/kg (max 100 mg) administered during each dialysis session.
* **Non-Dialysis CKD:** 0.5 mg/kg (max 100 mg) every 2 weeks for 5 doses.
* *Note: Safety and efficacy in children <2 years old are not well established.*
## Dose Adjustments
* **Hepatic Impairment:** No specific manufacturer dosage adjustment; use with caution.
* **Renal Impairment:** Dosing is specifically indexed to CKD status; no further renal adjustment required.
* **Hold:** Withhold if ferritin >800 ng/mL or if evidence of acute infection.
## Contraindications
* Hypersensitivity to iron sucrose or any component of the formulation.
* Evidence of iron overload (hemochromatosis).
* Anemias not associated with iron deficiency.
## Adverse Effects
* **Common:** Hypotension (during/after infusion), muscle cramps, nausea, injection site reactions, and headache.
* **Serious:** Anaphylaxis and hypersensitivity-type reactions (less common than with iron dextran, but possible).
## Key Drug Interactions
* **Oral Iron:** Do not administer oral iron concomitantly; IV iron will interfere with absorption and potentially increase toxic serum iron levels.
* **DMSA:** Iron may reduce the effectiveness of dimercaptosuccinic acid; avoid concurrent use.
## Monitoring
* **Baseline:** Hemoglobin, hematocrit, serum ferritin, and transferrin saturation (TSAT).
* **During Infusion:** Monitor for signs of hypersensitivity, hypotension, and vital signs during the infusion and for 30 minutes thereafter.
* **Follow-up:** Reassess hematologic parameters 4 weeks post-treatment.
## Clinical Pearls
* **Administration:** Slow administration decreases the risk of hypotension.
* **Compatibility:** Compatible with normal saline; do not mix with other medications or add to parenteral nutrition (may result in precipitation).
* **Hypersensitivity:** While skin testing is not required, have resuscitation equipment and staff trained in anaphylaxis management present during administration.
***
**Educational Disclaimer:** This information is for educational purposes only. Clinical practice protocols vary by institution. Always verify dosages, contraindications, and drug-drug interactions against current institutional guidelines and official prescribing information (e.g., DailyMed/FDA labels) before ordering or administering medication.
