Ferric gluconate: Ferrlecit and generics
Iron dextran: INFeD
Iron sucrose: Venofer
Parenteral iron

B/C	2	No	No	No
Key

• Injection:
  • Ferric gluconate (Ferrlecit and generics): 62.5 mg/mL (12.5 mg elemental Fe/mL) (5 mL); contains 9 mg/mL benzyl alcohol and 20% sucrose
  • Iron dextran (INFeD): 50 mg/mL (50 mg elemental Fe/mL) (2 mL); products containing phenol 0.5% are only for IM administration; products containing sodium chloride 0.9% can be administered via the IM or IV route
  • Iron sucrose (Venofer): 20 mg/mL (20 mg elemental Fe/mL) (2.5, 5, 10 mL); contains 300 mg/mL sucrose; preservative free

Dosing

• FERRIC GLUCONATE (IV):
• Iron deficiency anemia in patients undergoing chronic hemodialysis who are receiving supplemental erythropoietin therapy (most require 8 doses at 8 sequential dialysis treatments to achieve a favorable response):
  • Child ≥6 yr: 1.5 mg/kg elemental Fe (0.12 mL/kg) IV; max. dose: 125 mg elemental Fe/dose. Dilute dose in 25 mL NS and infuse over 1 hr.
  • Adult: 125 mg elemental Fe in 100 mL NS IV; infuse over 1 hr. Most require a minimum cumulative dose of 1 g elemental Fe administered over 8 sessions.
• IRON DEXTRAN (IV or IM):
• Iron deficiency anemia (≥4 mo, child, adolescent):
  • Test dose (IV over 5 min or IM; may initiate treatment dose 1 hr after test dose):
    • <10 kg: 10 mg
    • 10–20 kg: 15 mg
    • ≥20 kg: 25 mg
  • Total replacement dose of iron dextran (mL) = 0.0442 × lean body wt (kg) × (desired Hb [g/dL] − measured Hb [g/dL]) +  (0.26 × lean body wt [kg]). For patients weighing 5–15 kg, use actual body weight instead lean body weight. Total replacement dose is divided into smaller daily doses if exceeds respective IV or IM daily max. doses (see below).
• Acute blood loss: Total replacement dose of iron dextran (mL) = 0.02 × blood loss (mL) × hematocrit expressed as decimal fraction. Assumes 1 mL of RBC = 1 mg elemental iron
• If no reaction to test dose, give remainder of replacement dose ÷ over 2–3 daily doses.
• Max. daily IV dose: 100 mg
• Max. daily IM dose:
  • <5 kg: 0.5 mL (25 mg)
  • 5–10 kg:1 mL (50 mg)
  • >10 kg: 2 mL (100 mg)
    • IM administration: Use “Z-track” technique.
    • IV administration: Dilute in NS at a max. concentration of 50 mg/mL and infuse over 1–6 hr at a max. rate of 50 mg/min.
• IRON SUCROSE (IV):
• Test dose (optional): Infuse 25% of first day dose up to a max. of 25 mg undiluted over 30 min.
• Iron deficiency anemia in patients with chronic kidney disease:
  • Child:
    • ESRD on hemodialysis: (limited data from 14 children): 1 mg/kg/dialysis was adequate for correcting ferritin levels and 0.3 mg/kg/dialysis was successful in maintaining ferritin levels between 193 and 250 mCg/L. Doses were administered during the last hr of each dialysis and are recommended at a frequency of 3 times a week. A 10 mg test dose was administered.
    • Nonrenal iron deficiency, refractory to PO therapy (limited data): Calculate total iron replacement dose (mg) = 0.6 × wt (kg) × (100 − [measured Hb ÷ desired Hb × 100]). Replacement dose is administered by giving an initial dose of 5–7 mg/kg ( max. dose: 100 mg/24 hr) followed by a maintenance dose of 5–7 mg/kg/dose ( max. dose: 300 mg/24 hr) Q3–7 days until total iron replacement dose is achieved.
  • Adult:
    • Hemodialysis-dependent: 100 mg elemental Fe 1–3 times a wk during dialysis up to a total cumulative dose of 1000 mg. May continue to administer at lowest dose to maintain target Hb, Hct, and iron levels.
    • Nonhemodialysis-dependent: 200 mg elemental Fe on 5 different days over a 2 wk period (total cumulative dose: 1000 mg)
• IV administration: May administer undiluted over 2–5 min. For an infusion, dilute each 100 mg with a max. of 100 mL NS and infuse over at least 15 min.

Notes

• Oral therapy with iron salts is preferred; injectable routes are painful. Gluconate and sucrose salts may be better tolerated than iron dextran. Adverse effects include hypotension, GI disturbances, fever, rash, myalgia, arthralgias, cramps, and headaches. Hypersensitivity reactions have been reported for iron dextran and sucrose products; use of test dose prior to first therapeutic dose is recommended.
• IM administration is only possible with iron dextran salt product. Follow infusion recommendations for specific product. Monitor vital signs during IV infusion. TIBC levels may not be meaningful within 3 wk after dosing.
• Efficacy and safety of iron sucrose for maintenance therapy have been evaluated in children 2 yr and older with CKD and receiving erythropoietin therapy. Common side effects include headache, respiratory tract viral infection, peritonitis, vomiting, pyrexia, dizziness, and cough.
• Pregnancy category is “B” for ferric gluconate and iron sucrose and “C” for iron dextran.