Adult: In cases wherein oral Fe therapy is ineffective or impractical: Dosage is individualised according to patient's body weight and Hb level. As elemental iron: 100-200 mg 1-3 times weekly via slow inj over 2-5 minutes or via infusion at a rate of 100 mg/15 minutes.
Intravenous Iron deficiency anaemia in chronic kidney disease
Adult: Haemodialysis-dependent patients: 100 mg via slow inj over 2-5 minutes or via infusion over at least 15 minutes, during each consecutive dialysis session. Usual cumulative total dose: 1,000 mg. Non-dialysis-dependent patients: 200 mg via slow inj over 2-5 minutes or via infusion over 15 minutes. Doses are given in 5 different occasions over a 14-day period. Peritoneal dialysis-dependent patients: 2 doses of 300 mg via infusion over 1.5 hours administered 14 days apart, followed by 400 mg via infusion over 2.5 hours, 14 days later. Treatment course may be repeated as clinically indicated. Child: ≥2 years As maintenance therapy: Haemodialysis-dependent patients: 0.5 mg/kg (Max: 100 mg) every 2 weeks for 12 weeks. Non-dialysis-dependent or peritoneal dialysis-dependent patients receiving erythropoietin therapy: 0.5 mg/kg (Max: 100 mg) every 4 weeks for 12 weeks. Doses may be given via slow inj over 5 minutes or via infusion over 5-60 minutes. Treatment may be repeated if necessary.
What are the brands available for Iron sucrose in Malaysia?
Solution for infusion: Adult: Dilute in a max of 100 mL (dose ≤200 mg) or 250 mL (doses >200 mg) of NaCl 0.9% solution. Children: Dilute with 25 mL of NaCl 0.9% solution.
Contraindications
Hypersensitivity. Anaemia not associated with Fe deficiency; Fe overload or disturbances in Fe utilisation.
Special Precautions
Patient with history of severe asthma, eczema, other atopic allergy; immune or inflammatory conditions (e.g. SLE, rheumatoid arthritis); acute or chronic infections. Hepatic impairment. Pregnancy and lactation.
Adverse Reactions
Significant: Kounis syndrome (secondary to hypersensitivity reactions), hypotension; Fe overload with the possibility of iatrogenic haemosiderosis; infection. Gastrointestinal disorders: Dysgeusia, nausea, abdominal pain, diarrhoea, constipation. General disorders and administration site conditions: Inj or infusion site reactions, asthenia, fatigue, chills, peripheral oedema, pain. Investigations: Increased ALT, AST, GGT, serum ferritin. Musculoskeletal and connective tissue disorders: Myalgia, arthralgia, pain in extremity, back pain. Nervous system disorders: Dizziness, headache, paraesthesia, hypoaesthesia. Respiratory, thoracic and mediastinal disorders: Dyspnoea. Skin and subcutaneous tissue disorders: Rash, pruritus. Vascular disorders: Hypertension, phlebitis, flushing. Potentially Fatal: Serious hypersensitivity reactions (e.g. anaphylactic or anaphylactoid reactions).
This drug may cause dizziness, light headedness or confusion, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor haematocrit, Hb, transferrin, percent transferrin saturation (TSAT), total iron-binding capacity (TIBC), serum ferritin or Fe. Evaluate iron status at least 48 hours after the last dose. Monitor for signs and symptoms of hypersensitivity reactions (during and for at least 30 minutes after each infusion), hypotension, and systemic infection.
Overdosage
Symptoms: Fe overload, manifested as haemosiderosis. Management: Supportive treatment. May administer Fe chelating agents, if necessary.
Drug Interactions
May reduce the absorption of oral Fe preparations.
Action
Description: Mechanism of Action: Iron sucrose, a polynuclear iron (III)-hydroxide complex, is dissociated by the reticuloendothelial system into iron and sucrose. The iron is transported as a complex with transferrin to the target cells including erythroid precursor cells. This results in increased serum iron concentrations and is incorporated into the haemoglobin. Pharmacokinetics: Distribution: Enters breast milk. Metabolism: Dissociated by the reticuloendothelial system into iron and sucrose. Excretion: Via urine (5%). Elimination half-life: Approx 6 hours.
Chemical Structure
Iron sucrose Source: National Center for Biotechnology Information. PubChem Compound Summary for , Iron Sucrose. https://pubchem.ncbi.nlm.nih.gov/compound/Iron-Sucrose. Accessed Nov. 28, 2024.
Anon. Iron Sucrose. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 30/09/2024.Brayfield A, Cadart C (eds). Iron Sucrose. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 30/09/2024.Iron Sucrose. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 30/09/2024.Joint Formulary Committee. Iron Sucrose. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 30/09/2024.Seqirus (NZ) Ltd. Venofer 20 mg/mL Solution for Injection data sheet 18 July 2024. Medsafe. http://www.medsafe.govt.nz. Accessed 30/09/2024.Sucrofer Injection USP 20 mg/mL (Baxter Healthcare [Malaysia] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 30/09/2024.Venofer 20 mg Iron/mL, Solution for Injection or Concentrate for Solution for Infusion (Vifor France). MHRA. https://products.mhra.gov.uk. Accessed 30/09/2024.Venofer Injection, Solution (American Regent, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 30/09/2024.
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