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Iron Sucrose; Uses, Dosage, Side effects, Interactions

Iron Sucrose/Iron saccharate (Sucroferric oxyhydroxide or Iron Sucrose) is used as a source of iron in patients with iron deficiency anemia with chronic kidney disease (CKD), including those who are undergoing dialysis (hemodialysis or peritoneal) and those who do not require dialysis. Due to fewer side effects than iron dextran, iron saccharate is more preferred in chronic kidney disease patients.

Iron sucrose is an intravenously administered iron product indicated in the treatment of iron deficiency anemia. It is frequently used in patients undergoing hemodialysis, those undergoing erythropoietintherapy, and/or patients who have chronic kidney disease. It is a type 2 complex which limits the maximum dose that can be given to 1000mg which requires 5-10 administrations. A nonreducing disaccharide composed of glucose and fructose linked via their anomeric carbons. It is obtained commercially from sugarcane, sugar beet (beta vulgaris), and other plants and used extensively as a food and a sweetener. The drug consists of ferric hydroxide solubilized in aqueous sucrose. Upon IV administration, the iron is distributed to ferritin, the normal iron storage protein.

Mechanism of Action of Iron Sucrose

Normal erythropoiesis depends on the concentration of iron and erythropoietin available in the plasma, both being decreased in renal failure. Exogenous administration of erythropoietin increases red blood cell production and iron utilization, contributing to iron deficiency in hemodialysis patients. Intravenous iron has been used to treat the anemia associated with hemodialysis and may reduce the need for erythropoietin dosage by about 40%. Following IV administration of iron sucrose, sucroferric oxyhydroxide, the complex of polynuclear iron (III)-hydroxide in sucrose is dissociated into iron and sucrose by the reticuloendothelial system. In addition, a competitive exchange of iron takes place from the iron sucrose complex to the iron-binding protein transferrin. A therapeutic response to treatment with iron therapy is dependent upon the patient’s iron stores and the ability to use the iron. Use of iron is influenced by the cause of the deficiency as well as other illnesses that can affect normal erythropoiesis. Protein-energy malnutrition can prevent the incorporation of iron into the erythrocyte regardless of the quantity of iron stored. Only when lean body mass expands will iron be used. Iron therapy alone does not increase red blood cell production. Administration of iron only improves anemia which is associated with iron deficiency.
Iron-containing proteins and enzymes are important in oxidation-reduction reactions, especially those of the mitochondria. Iron is a component of myoglobin and several heme-enzymes, including the cytochromes, catalase, and peroxidase. Iron is an essential component of the metalloflavoprotein enzymes and the mitochondrial enzyme alpha-glycerophosphate oxidase. Iron-containing proteins and enzymes are important in oxidation-reduction reactions, especially those of the mitochondria. Furthermore, iron is a cofactor for enzymes such as aconitase and tryptophan pyrrolase. Iron deficiency not only causes anemia and decreased oxygen delivery, it also reduces the metabolism of muscle and decreases mitochondrial activity. Iron deficiency can also lead to defects in learning or thermoregulation. Thus iron is important to several metabolic functions which are independent of its importance to erythropoesis.
In the management of serum phosphorus concentrations in patients with chronic kidney disease, oral iron sucrose, sucroferric oxyhydroxide is a phosphate binder. Oral iron sucrose, sucroferric oxyhydroxide binds dietary phosphate within the gastrointestinal tract via ligand exchange between hydroxyl groups and/or water in iron sucrose, sucroferric oxyhydroxide and the phosphate in the diet. Bound phosphate is eliminated in the feces. As a result of reduced absorption of dietary phosphate, both serum phosphorus and calcium-phosphorus product concentrations are reduced.

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Indications of Iron Sucrose

Iron Deficiency Anemia
Chronic kidney disease
Pregnancy & Lactation
Adult men, Adolescent males, and Postmenopausal women
Adolescent menstruating, premenopausal women
To restore hemoglobin and replenish iron stores in iron-deficiency anemia due to causes other than blood loss.
It is used to replenish body iron stores in Non-Dialysis Dependent-Chronic Kidney Disease (NDD-CKD) patients receiving or not receiving erythropoietin and in Hemodialysis Dependent (HDD-CKD) and Peritoneal Dialysis Dependent (PDD-CKD) – Chronic Kidney Disease patients receiving an erythropoietin.
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.
Iron sucrose is elemental iron as an injection. It replenishes body iron stores in patients with iron deficiency.

Contra-Indications of Iron Sucrose

Increased Bodily Iron from High Red Blood Cell Destruction
Abnormally low blood pressure
Too Much Iron in the Blood for a Long Period of Time
Allergic to iron or any ingredients of the medication
Taking oral iron supplements
History of asthma (if the intravenous injection is used)
Acute kidney infection
Allergies to Iron Complex & Iron Analogues

The Dosage of Iron Sucrose

Strengths: Injection: 50 mg/2.5 mL, 100 mg/5 mL, or 200 mg/10 mL (20 mg/mL) in single-dose vials

Iron Deficiency Anemia

Hemodialysis Dependent Chronic Kidney Disease (HDD-CKD)

5 mL (100 mg elemental iron) undiluted slow IV over 2 to 5 minutes. Alternatively, 5 mL (100 mg elemental iron) diluted in a maximum of 100 mL of 0.9% sodium chloride IV over at least 15 minutes. Repeat at consecutive hemodialysis sessions for a total cumulative dose of 1000 mg.

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Non- Dialysis Dependent Chronic Kidney Disease (NDD-CKD)

10 mL (200 mg elemental iron), undiluted, IV over 2 to 5 minutes administered on 5 different occasions within a 14- day period to achieve a total cumulative dose of 1000 mg within the 14- day period.
Alternatively, 25 mL (500 mg elemental iron), diluted in a maximum of 250 mL sodium chloride 0.9%, IV over 210 to 240 minutes administered on day 1 and day 14 to give a cumulative dose of 1000 mg within a 14- day period. However, there is limited experience with this dosage regimen. A clinical trial (n=30) reported hypotension in 2 patients following administration of this dosage regimen.

Peritoneal Dialysis Dependent Chronic Kidney Disease (PDD-CKD)

Two infusions of 15 mL (300 mg elemental iron) each diluted in a maximum of 250 mL of 0.9% sodium chloride administered IV over 90 minutes 14 days apart, followed by one infusion of 20 mL (400 mg elemental iron) diluted in a maximum of 250 mL of 0.9% sodium chloride administered over 150 minutes 14 days after second dose for a total cumulative dose of 1000 mg infused within a 28 day period.

Side Effects of Iron Sucrose

Most common

Abdominal or stomach discomfort
low blood pressure,
difficult, burning, or painful urination
increased potassium blood levels (hyperkalemia),
low blood sugar (hypoglycemia), and
diarrhea
symptoms of weakness, muscle pain (myalgia)
abdominal pain (GI complaints), lactic acidosis (rare)
low blood levels of vitamin B-12
nausea,vomiting
chest discomfort
chills, dizziness
bloating/abdominal distention
constipation
heartburn

More common

chest pain;
Abdominal or stomach discomfort
cough or hoarseness
decreased appetite
diarrhea
fast or shallow breathing
feeling like you might pass out;
swelling in your hands, ankles, or feet;
trouble breathing; or
dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure)
lower back or side pain
muscle pain or cramping
painful or difficult urination

Less common

muscle cramps;
weakness, tired feeling;
dizziness, anxiety, headache;
nausea, vomiting, stomach pain;
diarrhea, constipation;
ear pain;
sore throat, sinus pain or congestion;
decreased sense of taste;
joint pain; or
pain, swelling, burning, or irritation around the IV needle.
Bloating or swelling of the face, arms, hands, lower legs, or feet
blurred vision
chest pain or tightness in the chest
confusion
difficult or labored breathing
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
nervousness
pounding in the ears
rapid weight gain

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Drug Interactions of Iron Sucrose

Treatment with iron sucrose injections can make it harder for your body to absorb iron medications you take by mouth. Tell your doctor if you are taking iron supplements or other iron-based oral medications. 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.

ferrous fumarate
ferrous gluconate; or
ferrous sulfate, and others.

This list is not complete. Other drugs may interact with iron sucrose, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Pregnancy & Lactation of Iron Sucrose

FDA pregnancy category B

Pregnancy

This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while receiving this medication, contact your doctor immediately.

Lactation

This medication passes into breast milk. If you are a breastfeeding mother and are using iron dextran, it may affect your baby. Talk to your doctor about whether you should continue breastfeeding.