Iron sucrose doe
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Here is a comprehensive overview of iron sucrose based on authoritative medical textbooks:
Iron Sucrose (Venofer)
What It Is
Iron sucrose is an intravenous (IV) iron formulation — a polynuclear iron(III)-hydroxide in sucrose complex — used to treat iron deficiency anemia (IDA). It is administered parenterally when oral iron is inadequate or not tolerated.
Brand name: Venofer
Formulation: 20 mg/mL elemental iron (2.5, 5, 10 mL vials); contains 300 mg/mL sucrose; preservative-free
Indications
- Iron deficiency anemia in chronic kidney disease (CKD) — the primary FDA-approved indication
- Patients receiving erythropoietin/ESA therapy
- Iron malabsorption (e.g., sprue, short-bowel syndrome)
- Oral iron intolerance
- Supplement to total parenteral nutrition
- Pregnancy — used as IV iron replacement for IDA when oral therapy fails or is not tolerated
Dosing
Adults (CKD, hemodialysis-dependent):
- 100 mg elemental iron IV per dialysis session × 10 doses (total 1 g)
- Administer undiluted as a slow IV injection (1 mL/min) or diluted in 100 mL NS over ≥15 minutes
Non-dialysis CKD adults:
- 200 mg IV on 5 separate occasions within 14 days; or 500 mg on day 1 and day 14
Peritoneal dialysis:
- 300 mg IV over 1.5 hours on day 1 and day 15, then 400 mg over 2.5 hours on day 29
Pediatric (CKD, ≥2 years):
- Hemodialysis-dependent: 0.5 mg/kg (max 100 mg) per dialysis session × 6 doses
- Non-dialysis/peritoneal dialysis: 0.5 mg/kg (max 100 mg) × 3 doses over 45 days
Pregnancy (IV iron dose calculation):
- Dose (mg/kg) calculated based on body weight and hemoglobin deficit
Per the dosing table from Goodman & Gilman's:
| Formulation | Dosing |
|---|---|
| Iron sucrose | Multiple doses of 100–300 mg |
Pharmacology & Safety Profile
- Iron sucrose appears better tolerated and causes fewer adverse events than iron dextran. Like ferric gluconate, it has a favorable safety profile.
- No test dose required (unlike iron dextran)
- The sucrose shell dissociates in the body to release iron, which is then taken up by reticuloendothelial cells
Common adverse effects:
- Headache
- Respiratory infection (especially in pediatric patients with CKD)
- Urticaria, dyspnea, pruritus, tachycardia, chills, arthralgias (with IV iron generally)
Key Differences From Other IV Iron Agents
| Agent | Key Feature |
|---|---|
| Iron dextran | Lowest cost; risk of fatal anaphylaxis; test dose required |
| Ferric gluconate | Better tolerated than dextran; requires multiple doses |
| Iron sucrose | Good tolerability; no test dose; FDA-approved for CKD |
| Ferric carboxymaltose | Large single doses possible |
| Ferumoxytol | Rapid 15-min infusion; 1.02 g single dose |
Use in CKD / Dialysis
Iron sucrose is a mainstay of iron repletion in hemodialysis patients. Studies in CKD have examined proactive high-dose administration (400 mg/month up to a ferritin of 700 µg/L) versus reactive low-dose strategies. It can also have pro-inflammatory effects at high doses in CKD, which is an area of ongoing study.
Sources: Goodman & Gilman's The Pharmacological Basis of Therapeutics, Table 45-6; The Harriet Lane Handbook, 23rd ed.; Creasy & Resnik's Maternal-Fetal Medicine; Comprehensive Clinical Nephrology, 7th ed.
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