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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 consists of iron (III) hydroxide in complex with sucrose, providing a stable, water-soluble formulation for intravenous administration.
## Primary Indications
* Iron deficiency anemia in patients with chronic kidney disease (CKD), including those on dialysis and non-dialysis dependent.
* Treatment of iron deficiency anemia in patients who are intolerant to or have failed oral iron therapy.
## Adult Dosing
* **Hemodialysis-dependent CKD (HDD-CKD):** 100 mg IV during 10 consecutive dialysis sessions (total 1,000 mg). May repeat every 3–4 months if clinically indicated.
* **Non-Dialysis-dependent CKD (NDD-CKD):** 200 mg IV administered on 5 separate occasions over 14 days (total 1,000 mg).
* **Peritoneal dialysis-dependent CKD (PDD-CKD):** 300 mg IV at weeks 1 and 3, followed by 400 mg IV at week 5 (total 1,000 mg).
* **General Iron Deficiency (Oral intolerance):** Typically 200 mg IV per session, up to 5 sessions, depending on calculated iron deficit.
* **Maximum Dose:** Do not exceed 1,000 mg per course.
## Pediatric Dosing
* **HDD-CKD (Ages 2 years and older):** 0.5 mg/kg IV administered during dialysis sessions. Total dose should not exceed 100 mg per dose.
* **NDD-CKD or PDD-CKD:** Dosing is often weight-based; clinical practice varies widely. Consult local institutional protocols to determine if dosing is calculated based on Ganzoni formula or fixed weight-based weight tiers.
## Dose Adjustments
* **Renal Impairment:** Dosing is indicated by dialysis status (see above).
* **Hepatic Impairment:** No formal adjustments; however, use caution in patients with iron overload or significant liver disease.
* **Elderly:** Use the lower end of the dosing range initially.
## Contraindications
* Known hypersensitivity to iron sucrose or any of its components.
* Evidence of iron overload (hemochromatosis).
* Anemia not caused by iron deficiency.
## Adverse Effects
* **Common:** Hypotension, muscle cramps, nausea, injection site reactions, headache.
* **Serious:** Anaphylaxis and severe hypersensitivity reactions (monitor closely during administration). Consider initial test dose per institutional protocol, though not strictly required by labeling.
## Key Drug Interactions
* **Oral Iron:** Parenteral iron therapy must be held until oral iron supplementation is discontinued, as iron sucrose may significantly increase serum iron levels and reduce absorption/worsen toxicity.
* **ACE Inhibitors:** May increase the risk of hypersensitivity reactions.
## Monitoring
* **Safety:** Monitor blood pressure and pulse during and after administration. Observe for 30 minutes post-infusion for hypersensitivity.
* **Efficacy:** Measure serum ferritin and transferrin saturation (TSAT) 2–4 weeks after the completion of the course. Monitor hemoglobin/hematocrit periodically.
## Clinical Pearls
* **Administration:** Can be administered as a slow IV push (undiluted) or as an infusion diluted in 0.9% Normal Saline. Refer to package insert for specific infusion rates to reduce the risk of hypotension.
* **Safety:** Unlike iron dextran, iron sucrose does not have a "black box" warning requiring a mandatory test dose, but hypersensitivity vigilance remains essential.
* **Lab Interference:** Serum iron values will be falsely elevated if measured within 48 hours of drug administration.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice and institutional protocols vary; always verify current prescribing information, safety alerts, and specific hospital guidelines before prescribing or administering medication.
