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# Iron Sucrose ## Overview Iron sucrose is a parenteral iron preparation used to restore 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 (receiving erythropoietin). * Iron deficiency anemia in patients with non-dialysis dependent chronic kidney disease (NDD-CKD). * Iron deficiency anemia in patients with NDD-CKD who are receiving erythropoietin. ## Adult Dosing * **Hemodialysis-dependent CKD:** 100 mg intravenously (IV) during 10 consecutive dialysis sessions (total 1,000 mg course). * **Non-dialysis dependent CKD:** 200 mg IV on 5 separate occasions within a 14-day period (total 1,000 mg). * **Peritoneal dialysis-dependent CKD:** 300 mg IV in 2 doses, followed by 400 mg in 1 dose, over 14 days (total 1,000 mg). * *Note:* Dosing protocols may vary by institution. ## Pediatric Dosing * **Hemodialysis-dependent CKD:** 0.5 mg/kg (maximum 100 mg) administered during consecutive dialysis sessions, typically over 10 sessions. * **Non-dialysis dependent CKD:** 0.5 mg/kg (maximum 100 mg) every 1–2 weeks for 5 doses (total 2.5 mg/kg). * *Note:* Pediatric dosing is less standardized; consult hospital-specific protocols and clinical judgment. ## Dose Adjustments * **Hepatic Impairment:** No specific adjustment provided by the manufacturer. * **Renal Impairment:** No dose reduction required; dosing is predicated on the CKD status. * **Repeat Dosing:** May be repeated if iron deficiency recurs. ## 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 (often associated with too rapid infusion), muscle cramps, nausea, vomiting, injection site reactions. * **Serious:** Anaphylaxis and severe hypersensitivity reactions (monitor closely during administration). ## Key Drug Interactions * **Oral Iron:** Do not administer oral iron supplements while receiving IV iron; oral iron absorption is inhibited and may lead to toxicity or false laboratory results. ## Monitoring * **Baseline:** Hemoglobin, hematocrit, serum ferritin, and transferrin saturation (TSAT). * **During/Post-Infusion:** Monitor for signs of hypersensitivity (bp, pulse, respiratory status) for at least 30 minutes post-infusion. * **Follow-up:** Check ferritin and TSAT periodically to assess adequacy of stores and prevent iron overload. ## Clinical Pearls * **Administration:** May be given as a slow IV push (undiluted) or as an IV infusion (diluted in 100 mL of 0.9% NaCl). Follow specific facility guidelines regarding infusion rate limits to minimize risk of hypotension. * **Hypotension:** If hypotension occurs, slow or stop the infusion. * **Compatibility:** Do not mix or add other medications to the iron sucrose solution. *** **Educational Disclaimer:** This information is for educational purposes only. Clinical practice and dosing protocols vary by institution. Always consult the most recent FDA-approved prescribing information, local institutional guidelines, and a clinician before administering medication.