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# Iron Sucrose (Intravenous) ## Overview Intravenous iron sucrose is a colloidal solution of iron(III) in a complex with sucrose. It is used to treat iron deficiency anemia (IDA) when oral iron is ineffective or not tolerated, or when rapid iron replenishment is required. ## Primary Indications * Iron deficiency anemia (IDA) when oral iron is ineffective or not tolerated. * Chronic kidney disease (CKD) patients on erythropoiesis-stimulating agents (ESAs). * Other conditions requiring rapid iron repletion where oral iron is not suitable. ## Adult Dosing Dosing is highly individualized based on the degree of iron deficiency and patient weight. **Exact dosing regimens depend on local protocol and should be confirmed.** A common approach involves a total dose of 1000 mg to 2000 mg administered in divided doses. * **Individual dose:** Typically 100 mg to 200 mg (as elemental iron). * **Maximum single dose:** 200 mg (as elemental iron). * **Maximum weekly dose:** 1000 mg (as elemental iron). **Example dosing strategy:** * **For patients weighing > 50 kg:** If hemoglobin < 10 g/dL, total iron replacement dose = 1.5 g (1500 mg). Administer as 500 mg on 3 occasions (e.g., days 1, 8, 15), or other regimens as per local protocol. * **For patients weighing < 50 kg:** If hemoglobin < 10 g/dL, total iron replacement dose = 1.0 g (1000 mg). Administer as 250 mg on 4 occasions. ## Pediatric Dosing Established pediatric dosing is limited and varies significantly by age and weight. **Consult specific pediatric guidelines and local protocols.** General recommendations *may* include: * **Children < 5 years:** Doses are typically lower, often 0.5 mg/kg to 2.5 mg/kg elemental iron per dose. * **Children ≥ 5 years:** Similar to adult dosing, but often dosed on a weight-based calculation of total iron deficit. * **Maximum single dose:** Generally 100 mg elemental iron. ## Dose Adjustments No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised in severe hepatic impairment. ## Contraindications * Hypersensitivity to iron sucrose or any component of the product. * Iron overload. * Anemia not caused by iron deficiency. ## Adverse Effects * **Common:** Headache, nausea, vomiting, diarrhea, constipation, muscle pain, joint pain, injection site reactions (pain, swelling, phlebitis). * **Serious:** **Hypersensitivity reactions (including anaphylaxis)**, hypotension, bronchospasm, rash, urticaria, pruritus, chest pain. ## Key Drug Interactions * **Oral iron preparations:** Concomitant use with oral iron may reduce the absorption of oral iron. Separate administration by at least 5 days. * **ACE Inhibitors:** May potentiate hypotension. ## Monitoring * **Iron studies:** Serum ferritin, transferrin saturation (TSAT) to assess iron repletion. * **Hemoglobin/Hematocrit:** To assess response of anemia. * **Signs and symptoms of hypersensitivity:** Observe patients for at least 30 minutes following administration. * **Blood pressure:** Monitor for hypotension. ## Clinical Pearls * Administer intravenously only, either as a slow intravenous injection or infusion. * **Dilute before infusion:** Typically diluted in 0.9% sodium chloride to a final concentration of 0.5 mg/mL to 2 mg/mL elemental iron. * **Rapid infusion can increase the risk of hypotension and hypersensitivity reactions.** * Effectiveness and safety in patients with active malignancy are not well established. * Store at controlled room temperature and protect from light. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the official prescribing information and current clinical guidelines before making treatment decisions. Drug information can change rapidly.