Iron Sucrose

Iron Sucrose Injection is a brown, sterile, aqueous, complex of polynuclear iron (III) hydroxide in sucrose for intravenous use. Following IV administration, it is dissociated into iron and sucrose by the reticuloendothelial system, and iron is transferred from blood to a pool of iron in liver and bone marrow. Ferritin binds and sequesters iron in a nontoxic form, and transferrin carries iron to tissues. Its elimination half-life is 6 hours.

• Iron deficiency anaemia (where rapid iron supply is needed)
• Patients who cannot tolerate oral iron therapy or are non-compliant
• Active inflammatory bowel disease (oral iron preparations ineffective)
• Non-dialysis dependent CKD (NDD-CKD) - with/without erythropoietin
• Hemodialysis dependent CKD (HDD-CKD) - with erythropoietin
• Peritoneal dialysis dependent CKD (PDD-CKD) - with erythropoietin
• Iron deficiency anaemia in surgical patients, blood donors, postpartum patients

Adult Dose (IV):

• 5-10 mL (100-200 mg Iron) once to three times weekly (depending on hemoglobin level)
• Maximum 10 mL (200 mg) per injection
• Test dose: 1 mL (20 mg) in adults over 1-2 minutes; wait 15 minutes

Child Dose (IV):

• Limited data; not to exceed 0.15 mL/kg (3 mg Iron/kg) once to three times weekly
• Test dose: >14 kg: 1 mL; <14 kg: half daily dose (1.5 mg Iron/kg)

Side Effects:

• Hypotension
• Cramps/leg cramps
• Nausea
• Headache
• Vomiting
• Diarrhea
• Dizziness
• Pruritus
• Application site reaction
• Anaphylactoid reactions (wheezing, dyspnea, hypotension, rashes)

Precautions:

• Body iron excretion is limited; withhold iron in presence of tissue iron overload
• Periodic monitoring of hematologic and haematinic parameters (hemoglobin, hematocrit, serum ferritin, transferrin saturation)
• Serious hypersensitivity reactions have been rarely reported
• Hypotension: related to rate of administration and total dose; administer according to recommended guidelines

Contraindications:

• Evidence of iron overload
• Known hypersensitivity to Iron Sucrose or any inactive components
• Anaemia not caused by iron deficiency
• History of allergic disorders (asthma, eczema, anaphylaxis)
• Liver disease and infections

Drug Interactions:

• Should not be administered concomitantly with oral iron preparations (absorption of oral iron is reduced)
• Oral iron therapy should not be given until 5 days after last injection

Use in Pregnancy: Category B; no adequate and well-controlled studies; use during pregnancy only if clearly needed.

Use in Lactation: It is not known whether Iron Sucrose is excreted in human milk; caution should be exercised.

Renal Impairment: Monitor serum ferritin and transferrin saturation; avoid iron overload; dosing protocols provided for dialysis patients.

Hepatic Impairment: Contraindicated in liver disease.

Overdose: Dosages in excess of iron needs may lead to hemosiderosis; symptoms of overdose or too rapid infusion: hypotension, headache, vomiting, nausea, dizziness, joint aches, paresthesia, abdominal and muscle pain, edema, cardiovascular collapse; treat with IV fluids, hydrocortisone, and/or antihistamines.