iron sucrose (Rx)

Brand and Other Names:Venofer
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 20mg (Fe)/mL

Iron Deficiency Anemia

Indicated for treatment of iron deficiency anemia associated with chronic kidney disease

Hemodialysis-dependent CKD: 100 mg elemental iron IV (injection or infusion over 2-5 min) per dialysis session not to exceed total cumulative dose of 1000 mg divided in 3 doses/week

Non-dialysis-dependent CKD: 200 mg IV injection for 5 doses in over 14 days (cumulative 1000 mg in 14-day period)

Peritoneal dialysis-dependent CKD: 300 mg IV infusion (1.5 hr) for 2 doses 14 days apart, THEN 400 mg IV infusion (2.5 hr) 14 days later (cumulative 1000 mg divided in 3 doses/week)

Dosage Forms & Strengths

injectable solution

  • 20mg (Fe)/mL

Iron Deficiency Anemia

Indicated for maintenance treatment of iron-deficient anemia associated with chronic kidney disease

<2 years: Safety and efficacy not established

≥2 years

  • Hemodialysis-dependent: 0.5 mg/kg IV q2weeks for 12 weeks; not to exceed 100 mg/dose
  • Non-dialysis dependent or peritoneal-dependent (on erythropoietin): 0.5 mg/kg IV q4weeks for 12 weeks; not to exceed 100 mg/dose

Dosing Considerations

Iron replacement treatment in pediatric patients has not been established

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Interactions

Interaction Checker

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              Serious - Use Alternative (14)

              • baloxavir marboxil

                iron sucrose will decrease the level or effect of baloxavir marboxil by cation binding in GI tract. Avoid or Use Alternate Drug. Baloxavir may bind to polyvalent cations resulting in decreased absorption. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. Human studies not conducted.

              • ciprofloxacin

                iron sucrose decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Administer ciprofloxacin at least 2 hours before or 6 hours after using these products. Use alternatives if available.

              • demeclocycline

                iron sucrose decreases levels of demeclocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • doxycycline

                iron sucrose decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • eltrombopag

                iron sucrose decreases levels of eltrombopag by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated. Separate by at least 4 hours.

              • fleroxacin

                iron sucrose decreases levels of fleroxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • gemifloxacin

                iron sucrose decreases levels of gemifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • levofloxacin

                iron sucrose decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • minocycline

                iron sucrose decreases levels of minocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • moxifloxacin

                iron sucrose decreases levels of moxifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • mycophenolate

                iron sucrose decreases levels of mycophenolate by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Interaction only with oral iron administration.

              • ofloxacin

                iron sucrose decreases levels of ofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • oxytetracycline

                iron sucrose decreases levels of oxytetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • tetracycline

                iron sucrose decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              Monitor Closely (30)

              • aluminum hydroxide

                aluminum hydroxide will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • calcium carbonate

                calcium carbonate will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • cimetidine

                cimetidine will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • deferasirox

                deferasirox decreases levels of iron sucrose by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferasirox chelates iron.

              • deferiprone

                iron sucrose decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.

              • deferoxamine

                deferoxamine decreases levels of iron sucrose by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron.

              • dexlansoprazole

                dexlansoprazole will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • didanosine

                didanosine will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Applies to didanosine chewable tablets and powder for oral solution; administer 2 hr before or several hours after didanosine oral solution or chewable tablet administration

              • esomeprazole

                esomeprazole will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • famotidine

                famotidine will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • ibandronate

                iron sucrose decreases levels of ibandronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • ibuprofen/famotidine

                ibuprofen/famotidine will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • lansoprazole

                lansoprazole will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • levothyroxine

                iron sucrose decreases levels of levothyroxine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • liothyronine

                iron sucrose decreases levels of liothyronine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • methyldopa

                iron sucrose decreases levels of methyldopa by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • nizatidine

                nizatidine will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • omadacycline

                iron sucrose will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

              • omeprazole

                omeprazole will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • pantoprazole

                pantoprazole will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • penicillamine

                iron sucrose decreases levels of penicillamine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Interaction only with oral iron administration.

              • rabeprazole

                rabeprazole will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • sarecycline

                iron sucrose will decrease the level or effect of sarecycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

              • sodium bicarbonate

                sodium bicarbonate will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • sodium citrate/citric acid

                sodium citrate/citric acid will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • sodium sulfate/?magnesium sulfate/potassium chloride

                sodium sulfate/?magnesium sulfate/potassium chloride decreases levels of iron sucrose by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer iron products at least 2 hr before and no less than 6 hr after each dose to avoid chelation with magnesium. .

              • sodium sulfate/potassium sulfate/magnesium sulfate

                sodium sulfate/potassium sulfate/magnesium sulfate decreases levels of iron sucrose by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer iron products at least 2 hr before and no less than 6 hr after each dose to avoid chelation with magnesium. .

              • thyroid desiccated

                iron sucrose decreases levels of thyroid desiccated by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • trientine

                trientine, iron sucrose. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hr.

              • vitamin E

                vitamin E decreases levels of iron sucrose by increasing hepatic clearance. Use Caution/Monitor.

              Minor (9)

              • benazepril

                iron sucrose, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

              • calcium acetate

                calcium acetate decreases levels of iron sucrose by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                iron sucrose increases levels of calcium acetate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • calcium carbonate

                calcium carbonate decreases levels of iron sucrose by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                iron sucrose increases levels of calcium carbonate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • calcium chloride

                calcium chloride decreases levels of iron sucrose by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                iron sucrose increases levels of calcium chloride by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • calcium citrate

                calcium citrate decreases levels of iron sucrose by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                iron sucrose increases levels of calcium citrate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • calcium gluconate

                calcium gluconate decreases levels of iron sucrose by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                iron sucrose increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • captopril

                iron sucrose, captopril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

              • gymnema

                gymnema decreases levels of iron sucrose by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • manganese

                iron sucrose decreases levels of manganese by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              Hypotension (36%)

              Muscle cramps (23%)

              Headache

              Nausea

              1-10%

              Dizziness

              Fatigue

              Arthralgia

              Back pain

              Hypertension

              Fluid overload

              Peripheral edema

              Cough

              Vomiting

              Diarrhea

              Constipation

              Pruritus

              Frequency Not Defined

              Potentially fatal anaphylaxis (rare)

              Iron overload

              Immune system disorders: Anaphylactic-type reactions, angioedema

              Psychiatric disorders: Confusion

              Nervous system disorders: Convulsions, collapse, light-headedness, loss-of-consciousness

              Cardiac disorders: Bradycardia

              Vascular disorders: Shock

              Respiratory, thoracic and mediastinal disorders: Bronchospasm, dyspnea

              Musculoskeletal and connective tissue disorders: Back pain, swelling of the joints

              Renal and urinary disorders: Chromaturia

              General disorders and administration site conditions: Hyperhidrosis

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              Warnings

              Contraindications

              Hypersensitivity

              Anemia not caused by iron deficiency

              Iron overload

              Cautions

              Risk of hypotension

              Withhold therapy in tissue iron overload

              Hypersensitivity

              • Serious hypersensitivity reactions reported, including anaphylactic-type reactions, some of which have been life-threatening and fatal
              • Patients may present with shock, clinically significant hypotension, loss of consciousness, and/or collapse
              • If hypersensitivity reactions or signs of intolerance occur during administration, stop infusion immediately
              • Monitor patients for signs and symptoms of hypersensitivity during and after administration for at least 30 minutes and until clinically stable following completion of the infusion
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              Pregnancy & Lactation

              Pregnancy

              Published studies on intravenous iron sucrose treatment after first trimester of pregnancy not shown adverse maternal or fetal outcomes; available reports of intravenous iron sucrose use in pregnant women during first trimester are insufficient to assess risk of major birth defects and miscarriage; iron deficiency anemia during pregnancy should be treated because there are risks to mother and fetus associated with untreated iron deficiency anemia (IDA) in pregnancy; risks to fetus associated with maternal severe hypersensitivity reactions

              Severe adverse reactions including circulatory failure (severe hypotension, shock including in the context of anaphylactic reaction) may occur in pregnant women with parenteral iron products which may cause fetal bradycardia, especially during second and third trimester

              Animal data

              • Animal reproduction studies of iron sucrose administered to rats and rabbits during period of organogenesis at elemental iron doses equivalent to maximum recommended human dose based on body surface area revealed no evidence of harm to the fetus; adverse outcomes in pregnancy occur regardless of health of mother or use of medications
              • Iron deficiency anemia during pregnancy should be treated; untreated IDA in pregnancy is associated with adverse maternal outcomes such as post-partum anemia; adverse pregnancy outcomes associated with IDA include increased risk for preterm delivery and low birth weight

              Lactation

              Iron sucrose is present in human milk, and available published reports following exposure to 100-300 mg intravenous iron sucrose have not reported adverse reactions in breastfed infants; there are no data on effects on milk production

              Developmental and health benefits of breastfeeding should be considered, along with mother’s clinical need for treatment and any potential adverse effects on breastfed child from therapy or from underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Replacement of iron stores found in hemoglobin, myoglobin, and enzymes; works to transport oxygen via hemoglobin

              Pharmacokinetics

              Half-life elimination: 6 hr

              Vd: 7.9-10 L

              Clearance: 1.2 L/hr

              Excretion: Urine (5%)

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              Administration

              IV Incompatibilities

              Do not mix with other medications or add to parenteral nutrition solutions for IV infusion

              IV Compatibilities

              Solution: 0.9% NaCl

              IV Preparation

              Do not dilute to concentrations below 1 mg/mL

              Add dose to 0.9% NaCl infusion bags (PVC or non-PVC); final concentrations range is 1-2 mg of elemental iron/mL

              Visually inspect for particulate matter and discoloration prior to infusion

              Stable for 7 days at controlled room temperature (25°C)

              Adults

              • HD-dependent and non-dialysis-dependent CKD: Dilute with up to 100 mL of 0.9% NaCl
              • PD-dependent CKD: Dilute with up to 250 mL of 0.9% NaCl

              Pediatrics

              • Dilute in 25 mL of 0.9% NaCl

              IV Administration

              Adults

              • HD-dependent CKD
                • Undiluted: Administer by slow IV injection over 2-5 min
                • Diluted solutions: Administer IV over 15 min
              • Non-dialysis-dependent CKD
                • Undiluted: Administer by slow IV injection over 2-5 min
                • Diluted solutions: Administer IV over 15 min
              • PD-dependent CKD
                • 300 mg doses: Infuse IV over 1.5 hr
                • 400 mg dose: Infuse IV over 2.5 hr

              Pediatric

              • Undiluted: Administer by slow IV injection over 5 minutes
              • Diluted solutions: Administer IV over 5-60 minutes

              Storage

              Unused vials

              • Store in original carton at 20-25°C (68-77° F); excursions permitted to 15- 30°C (59-86°F)
              • Do not freeze

              Diluted solutions

              • Syringe: Store at room temperature (25°C) or under refrigeration (4°C) for up to 7 days
              • IV infusion: Store at room temperature (25°C) for up to 7 days
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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Venofer intravenous
              -
              100 mg iron/5 mL vial
              Venofer intravenous
              -
              100 mg iron/5 mL vial
              Venofer intravenous
              -
              50 mg iron/2.5 mL vial
              Venofer intravenous
              -
              200 mg iron/10 mL vial
              Venofer intravenous
              -
              100 mg iron/5 mL vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              iron sucrose intravenous

              IRON SUCROSE - INJECTION

              (iron SOO-krose)

              COMMON BRAND NAME(S): Venofer

              USES: This medicine is used to treat "iron-poor" blood (anemia) in people with long-term kidney disease. You may need extra iron because of blood loss during kidney dialysis. Your body may also need more iron if you use the drug erythropoietin to help make new red blood cells.Iron is an important part of your red blood cells and is needed to transport oxygen in the body. Many patients with kidney disease cannot get enough iron from food and require injections.

              HOW TO USE: This medication is given by injection into a vein as directed by your doctor. It is usually given slowly over 2 to 5 minutes or as directed by your doctor. Iron sucrose can also be mixed in a saline solution and given through an IV over a longer time.Your dosage and length of treatment are based on your medical condition, age, and response to treatment. Your doctor will do laboratory tests to monitor your response. (See also Notes section.)If you are using this medication at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.

              SIDE EFFECTS: Muscle cramps, nausea, vomiting, strange taste in the mouth, diarrhea, constipation, headache, cough, back pain, joint pain, dizziness, or swelling of the arms/legs may occur. Pain, swelling, or redness at the injection site may occur. If these effects continue or worsen, tell your doctor.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Severe dizziness or fainting (hypotension) may occur while you are receiving IV iron. This may be helped by giving the medication more slowly or at a lower dose. Follow your doctor's directions carefully.Tell your doctor right away if you have any serious side effects, including: abdominal pain, chest pain, irregular heartbeat (arrhythmias), pressure in the chest, severe headache and blurred vision (hypertension), problems with your dialysis access site (graft).A very serious allergic reaction to this drug is unlikely, but get medical help right away if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using iron sucrose, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor.This medication passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: vitamin products, other iron-containing products.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Laboratory tests (such as complete blood count, ferritin, transferrin, total iron binding capacity-TIBC) should be performed periodically to monitor your progress or check for side effects. Keep all regular medical and laboratory appointments.Remember that it is best to get your vitamins and minerals from food whenever possible. Maintain a well-balanced diet, and follow any dietary guidelines as directed by your doctor. Foods rich in iron include meats (especially liver), eggs, raisins, figs, broccoli, brussels sprouts, beans, lentils, and iron-fortified or enriched cereals.

              MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

              STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

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              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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