Several parenteral
iron preparations are now available. This article focuses on
iron sucrose, a
hematinic, used more widely than any other for more than five decades, chiefly in Europe and now available in North America.
Iron sucrose has an average molecular weight of 34 to 60 kd, and after intravenous (IV) administration, it distributes into a volume equal to that of plasma, with a terminal half-life of 5 to 6 hours.
Transferrin and
ferritin levels can be measured reliably 48 hours after IV administration of this agent.
Iron sucrose carries no "black-box" warning, and a test dose is not required before it is administered. Doses of 100 mg can be administered over several minutes, and larger doses up to 300 mg can be administered within 60 minutes. The efficacy of
iron sucrose has been shown in patients with
chronic kidney disease (CKD) both before and after the initiation of dialysis
therapy.
Iron sucrose, like
iron gluconate, has been associated with a markedly lower incidence of life-threatening
anaphylactoid reactions and may be administered safely to those with previously documented intolerance to
iron dextran or
iron gluconate. Nonanaphylactoid reactions, including non-life-threatening
hypotension,
nausea, and
exanthema, also are extremely uncommon with
iron sucrose. Management of patients with the
anemia of CKD mandates that we carefully examine the effectiveness and safety of this oldest of
iron preparations and the accumulating present-day data regarding it and contemporaneous agents.