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 and 90% after 1–3 wk; the balance is absorbed slowly over months.

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	Weeks to months

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 2nd and 3rd trimesters; safety not established during 1st 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 ⬆ ⬇

Assess for hypersensitivity reactions and anaphylaxis (rash, dyspnea, loss of consciousness, hypotension, collapse, convulsions) for ≥30 min after injection. Resuscitation medication and equipment should be readily available.
Monitor for hypotension and other symptoms related to rapid infusion (headache, vomiting, nausea, dizziness, arthralgia, paresthesia, abdominal pain, edema, cardiovascular shock). If symptoms occur,↓ infusion rate and administer IV fluids, corticosteroids, and/or antihistamines.

Lab Test Considerations:

Monitor hemoglobin, hematocrit, serum ferritin, and transferrin saturation before and periodically during therapy. Transferrin saturation values ↑ rapidly after administration; therefore, serum iron values may be reliably obtained 48 hr after administration. If iron overload occurs, hold therapy.
- May ↑ AST and ALT.

Implementation ⬆ ⬇

Do not confuse Venofer with Vfend or Vimpat.
Do not administer iron sucrose concurrently with oral iron; will ↓ oral iron absorption.
- Solution is brown. Do not administer if discolored or contains particulates. Stable for 7 days at room temperature or refrigerated in syringe.
- Exercise caution when calculating and administering dose; overdose can be fatal.

IV Administration:

Hemodialysis-Dependent Patient

IV Push: Administer undiluted.
Rate: Administer 100 mg over 2–5 min into dialysis line within the 1st hr of dialysis session, not to exceed one vial per injection. Discard any unused portion.
Intermittent Infusion: Diluent: Dilute 100 mg iron sucrose in 100 mL of 0.9% NaCl.
Rate: Infuse over ≥15 min.

Non-Dialysis-Dependent Patients

IV Push: Administer undiluted.
Rate: Administer 200 mg over 2–5 min.
Intermittent Infusion: Dilute 200 mg in 100 mL of 0.9% NaCl or 500 mg in 250 mL of 0.9% NaCl.
Rate: Infuse 200 mg over 15 min. Infuse 500 mg over 3.5–4 hr on days 1 and 14.

Peritoneal Dialysis Patients

Intermittent Infusion: Diluent: Dilute each dose in 250 mL of 0.9% NaCl.
Rate: Infuse 300 mg over 1.5 hr or 400 mg over 2.5 hr.

Pediatric Patients

IV Push: Administer undiluted.
Rate: Administer 0.5 mg/kg, not to exceed 100 mg, over 5 min.
Intermittent Infusion: Dilute in 0.9% NaCl. Concentration: 1–2 mg/mL.
Rate: Infuse over 5–60 min.
Y-Site Incompatibility:
- cefiderocol
- dopamine
- tacrolimus

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Instruct patient to report symptoms of hypersensitivity reaction to health care provider immediately.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Maternal hypersensitivity reactions following use of parenteral iron may result in fetal bradycardia, especially during the 2nd and 3rd trimesters. Monitor breastfed infants for GI toxicity (constipation, diarrhea).

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇