Usage
Iron sucrose is prescribed for the treatment of iron deficiency anemia in patients with chronic kidney disease (CKD), including those on dialysis (hemodialysis or peritoneal dialysis) and those not on dialysis. It is classified as an iron replacement product. Iron sucrose provides a source of iron to stimulate erythropoiesis (red blood cell production) when oral iron therapy is ineffective or not tolerated.
Alternate Names
Iron(III)-hydroxide sucrose complex. Brand names include Venofer®.
How It Works
Pharmacodynamics: Iron sucrose replenishes depleted iron stores. After intravenous administration, the iron sucrose complex is taken up by the reticuloendothelial system, primarily in the liver, spleen, and bone marrow. The complex is then broken down, releasing iron. The released iron binds to transferrin for transport to developing red blood cells in the bone marrow, where it is incorporated into hemoglobin. This process increases hemoglobin levels and improves oxygen-carrying capacity.
Pharmacokinetics:
- Absorption: Iron sucrose is administered intravenously, bypassing the gastrointestinal tract.
- Distribution: Distributes to the reticuloendothelial system, primarily in the liver, spleen, and bone marrow.
- Metabolism: The iron sucrose complex is metabolized to release iron.
- Elimination: The released iron is utilized in hemoglobin synthesis or stored in the body; excess iron is slowly excreted through the kidneys.
Mode of Action: The iron component of iron sucrose is the active moiety. It doesn’t involve receptor binding, enzyme inhibition, or neurotransmitter modulation directly. Its action is based on supplying iron necessary for hemoglobin synthesis.
Dosage
Standard Dosage
Adults:
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Hemodialysis-Dependent CKD: 100 mg elemental iron by slow intravenous (IV) injection (over 2-5 minutes) or IV infusion (diluted in up to 100 mL of 0.9% sodium chloride, administered over at least 15 minutes) per dialysis session. A cumulative dose of 1 g is usually required.
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Non-Dialysis-Dependent CKD: 200 mg elemental iron by slow IV injection (over 2-5 minutes) or IV infusion (diluted in up to 100 mL of 0.9% sodium chloride, administered over 15 minutes) for a total of 5 doses administered on 5 different occasions over a 14-day period. Alternative dosing: 500 mg IV infusion (diluted in up to 250 mL 0.9% sodium chloride) on days 1 and 14, each dose administered over 3.5 to 4 hours.
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Peritoneal Dialysis-Dependent CKD: Three doses: 300 mg by IV infusion (diluted in up to 250 mL 0.9% sodium chloride over 1.5 hours), repeated 14 days later, followed by a 400 mg dose (diluted in up to 250 mL 0.9% sodium chloride over 2.5 hours) 14 days after the second dose.
Children: Dosing for iron replacement in pediatric CKD patients (2 years and older) on hemodialysis, peritoneal dialysis, or not on dialysis has not been definitively established. For maintenance therapy, 0.5 mg/kg elemental iron (not exceeding 100 mg per dose) is administered intravenously every 2 weeks for 12 weeks.
Special Cases:
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Elderly Patients: Dose selection should be cautious, starting at the lower end of the dosing range, reflecting age-related decreases in hepatic, renal, or cardiac function.
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Patients with Renal Impairment: Dosage adjustments are not typically necessary in CKD patients.
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Patients with Hepatic Dysfunction: No specific dosage adjustments are established. Caution is advised.
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Patients with Comorbid Conditions: Assess potential drug interactions with co-administered medications.
Clinical Use Cases
Iron sucrose dosage in these settings would follow standard guidelines for iron deficiency anemia in the context of the patient’s CKD status (hemodialysis, peritoneal dialysis, or non-dialysis dependent). Intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations do not necessitate specific dose adjustments.
Dosage Adjustments
Dose modification may be needed if significant adverse effects occur. Consult specific product information for details.
Side Effects
Common Side Effects:
Nausea, vomiting, diarrhea, constipation, dizziness, hypotension (especially after initial dose), injection site reactions (pain, swelling, bruising), headache, muscle cramps, joint pain.
Rare but Serious Side Effects:
Hypersensitivity reactions (including anaphylaxis), severe hypotension, loss of consciousness.
Long-Term Effects:
Iron overload if administered in excess of total iron needs.
Adverse Drug Reactions (ADR):
Anaphylaxis, severe hypotension.
Contraindications
- Hypersensitivity to iron sucrose or any component of the formulation.
- Anemia not caused by iron deficiency.
- Iron overload.
- First trimester of pregnancy (contraindicated in some regions, recommended only if clearly needed in others).
Drug Interactions
Iron sucrose can interact with certain medications:
- Oral iron: Avoid concurrent administration.
- Deferoxamine, dimercaprol: Do not administer concurrently.
- Chloramphenicol, deferasirox: May reduce iron sucrose effectiveness.
- Angiotensin-converting enzyme (ACE) inhibitors: May increase risk of hypotension.
- Other iron products: Avoid concomitant use due to increased risk of iron overload.
Pregnancy and Breastfeeding
- Pregnancy: Use with caution. Consult latest prescribing information for updated FDA Pregnancy Category and regional recommendations.
- Breastfeeding: Iron is present in human breastmilk. It’s unknown whether supplemental intravenous iron increases breastmilk levels. The decision to breastfeed while receiving iron sucrose should be made in consultation with a physician, considering the risks and benefits.
Drug Profile Summary
- Mechanism of Action: Replenishes iron stores to support erythropoiesis.
- Side Effects: Nausea, vomiting, hypotension, hypersensitivity.
- Contraindications: Hypersensitivity, non-iron deficiency anemia, iron overload, first trimester of pregnancy.
- Drug Interactions: Oral iron, deferoxamine, dimercaprol.
- Pregnancy & Breastfeeding: Consult prescribing information for detailed guidance and latest updates.
- Dosage: See detailed section above.
- Monitoring Parameters: Hemoglobin, hematocrit, serum ferritin, transferrin saturation, blood pressure during administration.
Popular Combinations
Iron sucrose is often used in conjunction with erythropoiesis-stimulating agents (ESAs) in patients with CKD.
Precautions
Monitor for hypersensitivity reactions during and after administration. Monitor blood pressure during and after each administration. Assess iron status before and during treatment. Avoid extravasation during IV administration.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Iron Sucrose?
A: See detailed dosage section above.
Q2: What are the most common side effects of Iron Sucrose?
A: Nausea, vomiting, dizziness, hypotension, injection site reactions (pain, swelling, bruising).
Q3: What are the serious side effects of Iron Sucrose?
A: Hypersensitivity reactions (including anaphylaxis), severe hypotension.
Q4: Can Iron Sucrose be administered to pregnant or breastfeeding women?
A: Consult prescribing information for detailed guidance and latest updates on pregnancy and breastfeeding safety.
Q5: How is Iron Sucrose administered?
A: Intravenously, either by slow IV injection or IV infusion.
Q6: What should I monitor in a patient receiving Iron Sucrose?
A: Blood pressure during and after administration, hemoglobin, hematocrit, serum ferritin, and transferrin saturation.
Q7: Can Iron Sucrose be mixed with other medications?
A: No, it should not be mixed with other medications or added to parenteral nutrition solutions.
Q8: Is a test dose recommended before administering Iron Sucrose?
A: While not routinely recommended by the manufacturer, test doses have been used in some patients at increased risk of hypersensitivity. Discuss with specialist.
Q9: What are the signs and symptoms of an allergic reaction to Iron Sucrose?
A: Hives, itching, difficulty breathing, swelling of the face, lips, tongue, or throat, lightheadedness, hypotension.
Q10: How should I manage a patient experiencing an allergic reaction to Iron Sucrose?
A: Discontinue the infusion immediately, provide supportive care (e.g., oxygen, IV fluids), and administer appropriate medications (e.g., antihistamines, epinephrine) as needed.
