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# Iron Sucrose ## Overview Iron sucrose is a parenteral iron complex used to treat iron deficiency anemia. It is formulated for slow intravenous (IV) administration. Unlike iron dextran, it does not require a test dose, though cautious monitoring for hypersensitivity is required. ## Primary Indications * Iron deficiency anemia in patients with chronic kidney disease (CKD), including those on dialysis (hemodialysis or peritoneal) and non-dialysis dependent CKD. * Iron deficiency anemia in patients intolerant to or unresponsive to oral iron. ## Adult Dosing * **Hemodialysis-Dependent CKD:** 100 mg administered intravenously during consecutive dialysis sessions for a total cumulative dose of 1,000 mg over 10 sessions. * **Non-Dialysis Dependent CKD:** 200 mg intravenously over 2–5 minutes, administered on 5 separate occasions within 14 days (total dose: 1,000 mg). * **Peritoneal Dialysis-Dependent CKD:** 300 mg via slow IV infusion (over 1.5 hours) at weeks 1, 3, and 5 (total dose: 900 mg). * **General Iron Deficiency Anemia (Intolerance to oral iron):** 200 mg via slow IV injection or infusion on 5 separate occasions within 14 days (total dose: 1,000 mg). * *Note: Repeat courses may be required if clinically indicated.* ## Pediatric Dosing * **Hemodialysis-Dependent CKD (ages 2 years and older):** 0.5 mg/kg (max 100 mg) intravenously every dialysis session for 10 sessions. * **Non-Dialysis Dependent CKD (ages 2 years and older):** 0.5 mg/kg (max 100 mg) intravenously administered every 2 weeks for 5 doses. * *Consult institutional protocols for weight-based titration and infusion rates.* ## Dose Adjustments * No specific renal or hepatic adjustments provided by the manufacturer, but clinical status (TSAT and ferritin) should guide decisions to withhold or adjust dosing. ## Contraindications * Known hypersensitivity to iron sucrose or any component of the product. * Evidence of iron overload (hemochromatosis). * Anemias not caused by iron deficiency. ## Adverse Effects * **Common:** Hypotension, muscle cramps, nausea, vomiting, injection site reactions, headache. * **Serious:** Hypersensitivity reactions (anaphylaxis, angioedema, respiratory distress), iron overload, hypotension (often related to rate of infusion). ## Key Drug Interactions * **Oral Iron:** Parenteral iron should generally be discontinued before initiating oral iron therapy, as oral absorption is significantly impaired and serum levels may be falsely elevated. ## Monitoring * **Baseline/Prior to Dose:** Hemoglobin, hematocrit, serum ferritin, and transferrin saturation (TSAT). * **During/Post-Administration:** Monitor for signs of hypersensitivity (hypotension, flushing, respiratory distress) for at least 30 minutes following administration. * **Long-term:** Avoid excessive iron accumulation; monitor ferritin regularly if repeating courses. ## Clinical Pearls * **Administration:** Iron sucrose must be administered slowly. Rapid injection can lead to hypotension. * **Incompatibility:** Do not mix with other medications or add to parenteral nutrition solutions. * **Hypotension:** If hypotension occurs during administration, slow the infusion rate or stop the infusion. * **Safety:** Always have resuscitation equipment and staff trained in anaphylaxis management available during administration. *** **Disclaimer:** This information is for educational purposes only. Always verify drug dosages, compatibility, and safety protocols with the most current clinical prescribing information, institutional pharmacy guidelines, and pharmacological databases (e.g., Lexicomp or Micromedex) before administration.