Initial Dosing of Iron Sucrose for Iron Deficiency Anemia

Dosing Guidelines

The initial dose of iron sucrose for the treatment of iron deficiency anemia is 100-300 mg per week for a total dose of 1-1.2 g during the induction phase, with repeated dosing limited to 200-300 mg per treatment episode 1, 2, 3
Iron sucrose is typically administered as 100-300 mg weekly during the induction phase for a total dose of 1-1.2 g, which may be repeated up to a total of 2-2.4 g 2, 3
Single doses of up to 7 mg/kg iron sucrose have been tested, but repeated dosing is generally limited to 200-300 mg per treatment episode 2, 3
A test dose is not required for iron sucrose, unlike iron dextran preparations which carry a risk for serious anaphylactic reactions 2, 3

For patients with hemoglobin 10-12 g/dL (women) or 10-13 g/dL (men) and ≥70 kg body weight: 1500 mg total dose 2, 3
For patients with hemoglobin 7-10 g/dL and ≥70 kg body weight: 2000 mg total dose 2, 3

Iron sucrose should be administered as a slow intravenous infusion 4, 5
The maximum individual dose is typically 200 mg per infusion 4, 5
For maintenance therapy in dialysis patients, the recommended dose is 2 mg/kg once or twice per month 6, 7

For hemodialysis patients, iron sucrose is typically administered at 100-300 mg/week for a total dose of 1-1.2 g 6, 7, 8
Maintenance dosing for dialysis patients is recommended at 2 mg/kg once or twice per month 6, 7

Iron sucrose has been used in pediatric patients at doses of 100-200 mg (median 200 mg) 9
In the USA, iron sucrose is approved for use in children from 2 years of age 9

Monitor hemoglobin levels to assess response, with an expected increase of at least 2 g/dL within 4 weeks of treatment 1, 2
The goal of iron supplementation is to normalize both hemoglobin levels and iron stores 1, 2
Avoid iron overload by maintaining transferrin saturation below 50% and serum ferritin below 800 μg/L 2, 3

Intravenous iron should be considered as first-line treatment in patients with clinically active inflammatory bowel disease, previous intolerance to oral iron, hemoglobin below 10 g/dL, or in patients who need erythropoiesis-stimulating agents 1, 2
Oral iron may be used in patients with mild anemia whose disease is clinically inactive and who have not previously been intolerant to oral iron 2, 3
Avoid evaluating iron parameters within the first 4 weeks after administration as circulating iron can interfere with assay results 10
The risk of iron overload in patients who are chronically bleeding (such as in inflammatory bowel disease) is intrinsically low 2, 3

The American Society of Clinical Oncology recommends administering iron sucrose 200 mg intravenously per infusion, given 2-3 times weekly, for a total cumulative dose based on body weight and hemoglobin level, with a maximum single dose of 200 mg per infusion, administered over 30 minutes minimum 11
Confirm iron deficiency with transferrin saturation (TSAT) <20% and ferritin <100 ng/mL in inflammatory conditions, as recommended by the American Society of Clinical Oncology 11

The American Journal of Hematology reports an anaphylaxis risk of exceedingly rare (<1:200,000 administrations) with iron sucrose 12