iron sucrose: clinical use

Prescribing considerations

• Confirm iron deficiency with appropriate laboratory tests before prescribing.
• Use only where trained staff can recognise and manage anaphylaxis and resuscitation facilities are immediately available.
• Prescribe and administer by the specific injectable-iron product because formulations are not interchangeable.
• Avoid paravenous leakage and stop administration immediately if hypersensitivity or intolerance develops.

Contraindications and cautions

• Hypersensitivity to iron sucrose, the product or its excipients
• Known serious hypersensitivity to another parenteral iron product
• Anaemia not caused by iron deficiency
• Iron overload or hereditary disturbance of iron utilisation
• Use caution with significant allergy or atopy, immune or inflammatory disease, hepatic dysfunction and acute or chronic infection; stop administration in bacteraemia

Monitoring

• Haemoglobin and indices of iron status, including ferritin and transferrin saturation as clinically appropriate
• Clinical observation for hypersensitivity during and after every administration, including after previously tolerated treatment
• Cannula site for pain, swelling or leakage
• Iron status in hepatic dysfunction to reduce the risk of overload
• Fetal wellbeing during administration in pregnancy

Clinical pharmacology

A polynuclear iron(III)-hydroxide core surrounded by sucrose molecules is taken up by the reticuloendothelial system. Iron is subsequently transferred to physiological transport and storage proteins and used in haemoglobin and other iron-dependent molecules.

Formulation and product differences

• Venofer is a dark-brown aqueous solution supplied in single-use glass ampoules or vials.
• It may be administered by intravenous infusion, slow intravenous injection or into the venous line of a dialysis machine; it is not for intramuscular use.
• For infusion it may be diluted only with sterile sodium chloride solution and must not be mixed with other medicines.
• Injectable iron products differ in indications, preparation and administration requirements and must not be treated as interchangeable.