iron sucrose

Absorption: Following IV administration, the uptake of iron by the reticuloendothelial system is constant at about 40–60 mg/hr. Following IM doses, 60% is absorbed after 3 days; 90% after 1–3 weeks, the balance is absorbed slowly over mo.

Distribution: Taken up by the reticuloendothelial system.

Metabolism/Excretion: Most sucrose is eliminated in urine. Most of the iron remains stored and used on demand. Small amounts eliminated in urine.

Half-Life: 6 hr.

Time/Action Profile ⬆ ⬇

(effects on erythropoiesis)

ROUTE	ONSET	PEAK	DURATION
IV	days	1–2 wk	wks–mos

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Anemia not due to iron deficiency;
Hemochromatosis, hemosiderosis, or other evidence of iron overload;
Hypersensitivity to iron sucrose.

Use Cautiously in:

Any evidence of tissue iron overload;
OB: Severe hypersensitivity reactions may occur that can lead to bradycardia in fetus, especially during second and third trimesters; safety not established during first trimester;
Lactation: Use during breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Children <2 yr (safety and effectiveness not established).

Adv. Reactions/Side Effects ⬆ ⬇

CV: chest pain, HF, hypertension, hypotension

Derm: pruritus

F and E: hypervolemia

GI: diarrhea, nausea, vomiting, ↑liver enzymes, abdominal pain

Local: injection site reactions

MS: leg cramps, musculoskeletal pain

Neuro: headache, dizziness, dysgeusia, weakness

Resp: cough, dyspnea

Misc: fever, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS), sepsis

Interactions ⬆ ⬇

Drug-drug:

Chloramphenicol and vitamin E may ↓ hematologic response to iron therapy.

Route/Dosage ⬆ ⬇

IV (Adults ): Hemodialysis dependent patients: 100 mg during each dialysis session for 10 doses (total of 1000 mg); may repeat if iron deficiency recurs; Non-dialysis dependent patients: 200 mg on 5 different days within a 14 day period to a total of 1000 mg; may also be given as infusion of 500 mg on day 1 and day 14; may repeat if iron deficiency recurs; Peritoneal dialysis patients: administered in a total cumulative dose of 1000 mg in 3 divided doses, 14 days apart within a 28 day period with first 2 doses of 300 mg and third dose of 400 mg; may repeat if iron deficiency recurs.
IV (Children ≥2 yr): Hemodialysis dependent patients (for iron maintenance therapy): 0.5 mg/kg (max = 100 mg/dose) every 2 wk for 12 wk; may repeat if necessary; Non-dialysis dependent patients or peritoneal dialysis patients who are receiving erythropoietin for iron maintenance therapy: 0.5 mg/kg (max = 100 mg/dose) every 4 wk for 12 wk; may repeat if necessary.

Availability ⬆ ⬇

Solution for injection: 20 mg/mL

Assessment ⬆ ⬇

Monitor BP during infusion. May cause hypotension; usually related to rate of administration and total dose administered.
Assess for hypersensitivity reactions and anaphylaxis (rash, dyspnea, loss of consciousness, hypotension, collapse, convulsions) for at least 30 min following injection. Equipment for resuscitation should be readily available.

Lab Test Considerations:

Monitor hemoglobin, hematocrit, serum ferritin, and transferrin saturation prior to and periodically during therapy. Transferrin saturation values ↑ rapidly after IV administration; therefore, serum iron values may be reliably obtained 48 hr after IV administration. Withhold iron therapy if evidence of iron overload occurs.
- May cause ↑ liver enzymes.

Toxicity and Overdose:

Symptoms of iron overdose or too rapid infusion are hypotension, headache, vomiting, nausea, dizziness, joint aches, paresthesia, abdominal and muscle pain, edema, and cardiovascular collapse. Treatment includes IV fluids, corticosteroids, and/or antihistamines. Administering at a slower rate usually relieves symptoms.

Implementation ⬆ ⬇

Do not confuse Venofer with Vfend or Vimpat.
Do not administer iron sucrose concurrently with oral iron, as the absorption of oral iron is reduced. Each mL vial contains 20 mg of elemental iron.
- Solution is brown. Inspect for particulate matter or discoloration. Do not administer solutions that contain particulate matter or are discolored. Solution is stable for 7 days at room temperature or if refrigerated in syringe or 7 days at room temperature diluted in IV bag.
- Exercise caution when administering and calculating doses; overdose can be fatal.

IV Administration:

Hemodialysis Dependent Patients

Most patients require a minimum cumulative dose of 1000 mg of elemental iron, administered over 10 sequential dialysis sessions, to achieve a favorable hemoglobin or hematocrit response.
IV Push: May be administered undiluted by slow injection.
Rate: Inject at a rate of 100 mg over 2–5 min into dialysis line early during the dialysis session (generally within the first hour), not to exceed one vial per injection. Discard any unused portion.
Intermittent Infusion: May be administered as an infusion of 100 mg diluted in a maximum of 100 mL of 0.9% NaCl.
Rate: Infuse over at least 15 minutes, per consecutive hemodialysis session.

Non-dialysis Dependent Patients

IV Push: May be administered as a slow injection of 200 mg undiluted.
Rate: Administer over 2–5 min.
Intermittent Infusion: Dilute 200 mg in 100 mL 0.9% NaCl. Has also been given as 500 mg diluted in 250 mL 0.9% NaCl.
Rate: Infuse over 15 min. Infuse 500 mg dose over 3.5–4 hr on days 1 and 14. May cause hypotension; monitor closely.
Additive Incompatibility: Iron sucrose should not be admixed with any other medications or parenteral nutrition solutions.

Peritoneal Dialysis Patients

Intermittent Infusion: Diluent: Dilute each dose in a maximum of 250 mL of 0.9% NaCl.
Rate: Administer doses of 300 mg over 1.5 hr and doses of 400 mg over 2.5 hr.

Pediatric Patients

IV Push: May be administered undiluted as 0.5 mg/kg, not to exceed 100 mg per dose.
Rate: Inject over 5 min.
Intermittent Infusion: Dilute in 0.9% NaCl at a concentration of 1 to 2 mg/mL. Do not dilute to concentrations below 1 mg/mL
Rate: Infuse over 5–60 min.

Patient/Family Teaching ⬆ ⬇

Explain purpose of iron therapy to patient.
Instruct patient to report symptoms of hypersensitivity reaction to health care professional immediately.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected, or if breastfeeding. Maternal hypersensitivity reactions (anaphylaxis, hypotension, shock) following use of parenteral iron may result in fetal bradycardia, especially during the second and third trimesters. Monitor breastfed infants for gastrointestinal toxicity (constipation, diarrhea).

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇