#venofer

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Common Brand Names: Infed (iron dextran), Venofer (iron sucrose)

Therapeutic Class: Essential mineral and blood modifier

Common Injectable Dosage Forms:

Iron Dextran, Solution for Injection: 50 mg/mL (2 mL)

Iron Sucrose, Solution for Injection: 20 mg/mL (5 mL)

Dosage Ranges:

Iron Dextran:

Children <15 kg: 0.0442 (desired hemoglobin – observed hemoglobin) x W ÷ (0.26 x W) Note: W=weight in kg, desired hemoglobin usually 12 g/dL.

Adults and children >15 kg: 0.0442 (desired hemoglobin - observed hemoglobin) x LBW ÷ (0.26 x LBW). Note: LBW=lean body weight in kg, desired hemoglobin usually 14.8 g/dL. A test dose of 0.5 mL should be given first day of therapy.

Iron Sucrose: 100-300 mg administered 1-3 times per week to a cumulative total maximum dose of 1000 mg; may administer lower doses to maintain target hemoglobin, hematocrit, and iron storage parameters.

Administration and Stability: Iron Dextran: IM injection use Z-track technique; IV test dose given over 5 minutes; subsequent doses given at a rate not to exceed 50 mg/minute or diluted in 250-1000 mL NS and infused over 1-6 hours. Iron Sucrose: Slow IV injection of 1 mL/minute (100 mg over 2-5 minutes); or infusion of 1 vial (100 mg/5 mL) in 100 mL NS over at least 90 minutes.

Pharmacology/Pharmacokinetics: Iron Dextran: The released iron, from plasma iron dextran, replenishes the depleted iron stores in bone marrow where it is incorporated into hemoglobin. Uptake of iron by the reticuloendothelial system is constant at about 10-20 mg/hour. Iron Sucrose: The reticuloendothelial system dissociates iron sucrose into iron and sucrose. The released iron increases serum iron concentrations and is incorporated into hemoglobin. Half-life elimination is approximately 6 hours.

Drug and Lab Interactions: Iron dextran may have decreased effect when administered with chloramphenicol. Iron sucrose may reduce absorption of oral iron preparations.

Contraindications/Precautions: Hypersensitivity to any component of the formulations and in anemia not associated with iron deficiency. Rare anaphylactic reactions have occurred during use, as well as hypotension. Use caution in patients with history of asthma, hepatic impairment, and rheumatoid arthritis when administering iron dextran. Iron dextran has a Pregnancy Category rating of C, iron sucrose is rated Pregnancy Category B.

Monitoring Parameters: Ferritin, hemoglobin, hematocrit, serum iron, transferrin

Adverse Effects: Both products have been associated with flushing, dizziness, metallic taste, and hypotension. Diaphoresis, urticaria, arthralgia, fever, chills, dizziness, headache, and nausea may be delayed 24-48 hours after IV administration or 3-4 days after IM administration.