Iron Sucrose

A to Z Drug Facts

 Actions Replenishes Hgb and depleted iron stores.

 Indications Treatment of iron deficiency anemia in patients undergoing chronic hemodialysis who are receiving erythropoietin therapy.

 Contraindications Iron overload; anemia not caused by iron deficiency.

 Route/Dosage

ADULTS: IV 100 mg elemental iron (5 mL) directly into dialysis line by slow injection (ie, 20 mg [1 mL] undiluted solution/min) or by infusion (ie, 100 mg of elemental iron diluted in a max of 100 mL of 0.9% NaCl infused over ³ 15 min). Most patients will require 1000 mg of elemental iron, administered over 10 sequential dialysis sessions.

 Interactions

Oral iron Absorption of oral iron may be reduced. Do not mix with other medication or add to parenteral nutrition solutions for IV infusion.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Hypotension; chest pain; hypertension; hypervolemia. CNS: Headache; malaise; dizziness. DERMATOLOGIC: Pruritus; application site reaction. GI: Nausea; vomiting; diarrhea; abdominal pain. HEPATIC: Elevated liver enzymes. RESPIRATORY: Dyspnea; pneumonia; cough. OTHER: Leg cramps; cramps; fever; pain; asthenia; musculoskeletal pain; hypersensitivity.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy not established. Elderly: Select dose with caution, reflecting greater frequency of decreased hepatic, renal, or cardiac function and comorbidity. Iron overload: Exercise caution and withhold iron administration in the presence of evidence of tissue iron overload. Hypersensitivity: Potentially fatal hypersensitivity reactions, including anaphylactic shock, may occur. Hypotension: Hypotension related to the rate of administration and total dose administered may occur.

 Administration/Storage

• Discontinue oral iron preparations before administering parenteral iron products.
• Dose is administered 1 to 3 times/wk. Do not administer > 3 times/wk.
• Administer by IV route only. Not for IM or SC administration.
• Administer prescribed dose directly into dialysis line either by slow injection or by infusion.
• For slow IV injection, administer undiluted solution at rate £ 1 mL/min. Max dose is 5 mL (1 vial).
• For IV infusion, dilute contents of 1 vial in 100 mL 0.9% NaCl immediately prior to infusion and infuse over 15 min. Discard any unused diluted solution.
• Do not mix with other IV medications or add to parenteral nutrition solutions.
• Do not administer if particulate matter or discoloration noted.
• Store vials at controlled room temperature. Protect from freezing.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Review patient’s health history for any condition that could contraindicate iron sucrose: evidence of iron overload, anemia not caused by iron deficiency.
• Ensure that patient is also receiving erythropoietin therapy.
• Ensure that hemoglobin, hematocrit, serum ferritin, and transferrin saturation are determined before and periodically during treatment.
• Monitor BP during infusion. If hypotension occurs, slow infusion rate. If hypotension continues, discontinue infusion.
• Monitor patient for signs of anaphylactic reaction during and shortly after infusion. Be prepared to respond if a serious reaction occurs.

 Patient/Family Education

• Explain name, dose, action, and potential side effects of drug.
• Advise patient that medication will be prepared and administered by health care provider during dialysis sessions and that medication will not be administered at home.
• Instruct patient to inform health care provider if noting any of the following symptoms during the administration of drug: anxiety, sweating, rapid heart beat, shortness of breath or difficulty breathing, swelling of the throat, rash, or itching.
• Advise patient that follow-up visits and laboratory tests will be required to monitor therapy, and to be sure to keep appointments.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts