IRON SUCROSE INJECTION

IRON SUCROSE INJECTION
(i'ron su'crose)
Venofer
Classifications: blood former; iron preparation; antianemic;
Therapeutic: antianemic
; iron deficiency replacement
Prototype: Ferrous sulfate
Pregnancy Category: B

Availability

20 mg elemental iron/mL

Action

A complex of polynuclear iron (III) hydroxide in sucrose. It is dissociated by the reticuloendothelial system (RES) into iron (ferric ion) and sucrose. Normal erythropoiesis depends on the concentration of iron (ferric ion) and erythropoietin available in the plasma; both are decreased in renal failure. Exogenous administration of erythropoietin increases red blood cell production and iron utilization, contributing to iron deficiency in hemodialized patients.

Therapeutic Effect

Increases serum iron (ferric ion) level in chronic renal failure patients, and results in increased hemoglobin level.

Uses

Treatment of iron deficiency anemia in patients with chronic renal failure (with or without concurrent administration of erythropoietin).

Contraindications

Patients with iron overload, hypersensitivity to Venofer, or for anemia not caused by iron deficiency; hemochromatosis; concomitant use with an oral iron preparation.

Cautious Use

Patients with a history of hypotension; pregnancy (category B), lactation; older adults, decreased renal, hepatic, or cardiac function. Safety and effectiveness in infants or children are not established.

Route & Dosage

Iron Deficiency Anemia
Adult: IV Hemodialysis dependent (HDD-CKD): 100 mg given at least 15 min per hemodialysis session (cumulative dose 1000 mg).  Non-hemodialysis dependent (NDD-CKD): 200 mg on 5 different occasions within the 14-d period.  Peritoneal dialysis dependent (PDD-CKD): 300 mg on days 1 and 15, then 400 mg 14 d later

Administration

Intravenous

PREPARE: Direct/Infusion: ?? HDD-CKD: Give direct IV undiluted or diluted immediately prior to infusion in a maxiumum of 100 mL NS.?? NDD-CKD: Give direct IV undiluted.?? PDD-CKD: Dilute 300–400 mg in a maxiumum of 250 mL of NS for infusion. 

ADMINISTER: Direct: Give slowly by direct IV the undiluted solution over 2–5 min.  IV Infusion: ??Infusion diluted solution for HDD-CKD patient over at least 15 min and for PDD-CKD patient over 90 min. ??Avoid rapid infusion. 

INCOMPATIBILITIES Solution/additive: Do not mix with other medications or parenteral nutrition solutions.

  • Store unopened vials preferably at 25° C (77° F), but room temperature permitted. Discard unused portion in opened vial.

Adverse Effects (≥1%)

Body as a Whole: Fever, pain, asthenia, malaise, anaphylactoid reactions. Cardiovascular: Hypotension, chest pain, hypertension, hypervolemia. Digestive: Nausea, vomiting, diarrhea, abdominal pain, elevated liver function tests. Musculoskeletal: Leg cramps, muscle pain. CNS: Headache, dizziness. Respiratory: Dyspnea, pneumonia, cough. Skin: Pruritus, injection site reaction.

Interactions

Drug: May reduce absorption of oral iron preparations.

Pharmacokinetics

Peak: 4 wk. Distribution: Primarily to blood with some distribution to liver, spleen, bone marrow. Metabolism: Dissociated to iron and sucrose in reticuloendothelial system. Elimination: Sucrose is eliminated in urine, 5% of iron excreted in urine. Half-Life: 6 h.

Nursing Implications

Assessment & Drug Effects

  • Withhold drug and notify physician when serum ferritin level equals or exceeds established guidelines.
  • Stop infusion and notify physician for S&S overdosage or infusing too rapidly: hypotension, edema; headache, dizziness, nausea, vomiting, abdominal pain, joint or muscle pain, and paresthesia.
  • Lab tests: Periodic serum ferritin, transferrin saturation, Hct, and Hgb.
  • Monitor patient carefully during the first 30 min after initiation of IV therapy for signs of hypersensitivity and anaphylactoid reaction (see Appendix F).

Patient & Family Education

  • Report any of the following promptly: Itching, rash, chest pain, headache, dizziness, nausea, vomiting, abdominal pain, joint or muscle pain, and numbness and tingling.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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