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# Iron Sucrose
## Overview
Iron sucrose is an intravenous iron preparation used to increase total body iron stores. It is a colloidal complex consisting of ferric hydroxide in sucrose. It is formulated exclusively for IV administration (slow injection or infusion).
## Primary Indications
Treatment of iron deficiency anemia (IDA) in patients undergoing chronic hemodialysis (CKD-HD), non-dialysis-dependent CKD (ND-CKD), and peritoneal dialysis-dependent CKD (PD-CKD).
## Adult Dosing
* **CKD-HD:** 100 mg administered intravenously during consecutive dialysis sessions, typically reaching a cumulative dose of 1,000 mg over 10 sessions. May repeat if clinically indicated.
* **ND-CKD:** 200 mg administered by slow IV injection over 2–5 minutes or infusion over 15 minutes on 5 different occasions within a 14-day period (total cumulative dose: 1,000 mg).
* **PD-CKD:** 300 mg via IV infusion over 1.5 hours administered at 14-day intervals for 3 doses (total cumulative dose: 900 mg).
## Pediatric Dosing
* **Ages 2 years and older:** 0.5 mg/kg (maximum 100 mg per dose) administered every 1-2 weeks as needed to re-establish iron stores.
* *Note: Dosing is highly variable and depends on institutional protocols/physician preference; verify local pediatric hematology guidelines.*
## Dose Adjustments
* **Renal Impairment:** Dosing is inherently based on the stage/type of renal disease (see Adult Dosing). No adjustments required for hepatic impairment.
* **Hypersensitivity:** If a reaction occurs, discontinue immediately.
## 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, dizziness, injection site reactions, and headache.
* **Serious:** Anaphylaxis and hypersensitivity reactions (may include flushing, rash, dyspnea, or hypotension).
## Key Drug Interactions
* **Oral Iron:** Do not administer concurrently. Oral iron absorption is significantly inhibited by IV iron administration. Wait at least 5 days after the last IV iron dose before starting oral iron.
## Monitoring
* **During Administration:** Monitor blood pressure and pulse carefully during and for 30 minutes post-infusion; observe for signs of hypersensitivity.
* **Laboratory Monitoring:** Monitor hemoglobin, hematocrit, serum ferritin, and serum transferrin saturation (TSAT) to assess iron status and prevent iron overload.
## Clinical Pearls
* **Administration:** Never administer as a bolus undiluted injection at a rate faster than 1 mL (20 mg iron) per minute.
* **Compatibility:** Must be diluted in 0.9% Normal Saline (NS) for infusion. Do not mix with other medications.
* **Test Dose:** Not routinely required, but caution is advised in patients with a history of drug allergies or immune-mediated disorders.
* **Hypotension:** If hypotension occurs during administration, decrease the rate of infusion; it is often related to the rate of administration rather than true hypersensitivity.
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**Disclaimer**: This information is for educational purposes only and does not replace professional clinical judgment. Always verify dosages, contraindications, and administration protocols against your institution's current formulary and national prescribing information (e.g., FDA labels or local equivalent).
