Parenteral Manual

Iron sucrose (NON-FORMULARY)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
VENOFER®
Classification: 
Iron replacement therapy
Original Date: 
August 2005
Revised Date: 
November 2018
Indications: 
  • Treatment of iron deficiency in combination with erythropoeitin where oral iron preparations cannot provide adequate supplementation, particularly in dialysis patients
Reconstitution and Stability: 
  • 100 mg/5 mL ampoule (20 mg/mL)
  • Store at room temperature. Protect from light
  • Stable for 48 hours at room temperature or in the fridge when diluted in NS at a concentration of 0.5 - 2 mg/mL and stored in minibags or plastic syringes
Compatibility: 

- Solutions Compatible: NS

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: no information

Incompatible: DO NOT mix with other drugs or add to parenteral nutrition solutions

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

YES , doses < 100 mg only 
Usual dilution: undiluted
Infusion rate: do not exceed 20 mg/minute

IV Intermittent Infusion

YES, doses < 100 mg only 
Usual dilution: 1 mg/mL
Infusion time: 60 minutes. 
  
doses <  500 mg   
Usual dilution: 1 mg/mL
Infusion time: 1 - 4 hours

IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:

Usual Dose: 

  • 2 mg/kg once weekly
  • Maximum: 7 mg/kg (up to 300 mg) for Non Renal patients. Doses of 7 mg/kg (up to 500 mg) in Non-Hemodialysis patients.

Adult:

Usual Dose:  

  • 100 mg 1-3 times/week to a cumulative dose of 1000 mg
  • Maximum IV push: 100 mg
  • Maximum IV intermittent: 200 mg
Potential hazards of parenteral administration: 
  • Anaphylaxis, urticaria
  • Hypotensive reactions, especially with rapid injection
  • Phlebitis, venous spasm
  • Fever, edema, muscle pain, parathesia
  • Wheeze, bronchospasm, chest pain, shivering, dyspnea, cyanosis, respiratory arrest
  • Nausea, headache, vomiting
  • Reduced absorption of oral iron (concurrent therapy not recommended)
Notes: 
  •  Iron sucrose is reported to have fewer adverse reactions and allergic reactions than iron dextran and may be used in patients who have reacted to iron dextran
  • Patients receiving oral iron should hold it throughout the course of therapy with IV iron
  • Serum Fe indices may not be accurate when drawn too close to IV iron administration.  Try to allow at least one week after administration of IV iron before measuring.
  • See "Intravenous Iron Therapy for Pediatric Hemodialysis Patients" in the dialysis unit

ANAPHYLAXIS PRECAUTIONS:
- Have epinephrine, diphenhydramine and hydrocortisone available at bedside and in portable kit for patient transport off unit. 
- Dosage guidelines (Administer in sequence listed):

  • Epinephrine (Adrenalin®) (1:1,000 is 1 mg/mL)______ mg = _______mL(0.01 mg/kg/dose = 0.01 mL/kg/dose, Max. 0.5 mg = 0.5 mL) IM in the thigh or alternative large muscle q15 minutes x 2, then Q4H PRN.
  • Diphenhydramine [Benadryl®] __________ mg (1 mg/kg/dose, Max. 50 mg) I.V. x 1, then Q6H PRN.
  • Hydrocortisone [Solu-cortef®] __________ mg (2.5 mg/kg/dose) I.V. x 1, then Q4H PRN

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