iron sucrose

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.

Availability ⬆ ⬇

Solution for injection: 20 mg/mL

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.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Enters the bloodstream and is transported to the organs of the reticuloendothelial system (liver, spleen, bone marrow) where it becomes separated from the sucrose complex and becomes part of iron stores.

Therapeutic effects:

Resolution of iron deficiency anemia associated with chronic kidney disease.

Classifications ⬆ ⬇

Therapeutic Classification: antianemics

Pharmacologic Classification: iron supplements

Pharmacokinetics ⬆ ⬇

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

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).

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Indications ⬇

Contraind./Precautions ⬆ ⬇