Iron sucrose vs Iron Dextran

	Iron Dextran 50mg Fe/ml Injection (2ml ampoule) COSMOFER	Iron Sucrose 100mg/5ml Injection (5ml ampoule ) VENOFER
Availability  (Prescribing category)	100mg of Iron in 2ml  (B)	100mg of Iron in 5ml  (B)
Indication	Treatment of iron deficiency for >14 years old	Treatment of iron deficiency for adult and children In children, recommended to not exceed 0.15ml/kg body weight one to three times per week
Dosing and Administration	An initial test dose of 0.5ml should be given over the desired route Can be given as multiple doses of 2 mL (equivalent to 100 mg elemental iron, based on a concentration of 50 mg elemental iron per mL). Can also be given as a single, total dose infusion up to 20mg iron/kg body weight For severe iron deficiency anaemia, 1 to 2ml daily given by deep IM. Dosage is individualized according to total iron deficit	An initial test dose is required only if patient has allergies history Given over multiple infusions, with a maximum individual dose of 10 to 15 mL (equivalent to 200 to 300 mg elemental iron, based on a concentration of 20 mg elemental iron per mL) By IV drip infusion, slow IV injection or directly into the venous limb of dialyser. Cannot be given IM.
Number of doses required	Can be administered in one or two visits (Frequent visiting not necessary)	If patient has frequent visits low doses can be administered
Cost	The least expensive	More expensive
Adverse Effects	Comparable Less nephrotoxic In CKD patients stage 3 & 4 compared to iron sucrose	Comparable More nephrotoxic in CKD patients stage 3&4 compared to iron dextran

RECOMMENDATIONS

• If total dose of iron needed is high, then iron dextran is preferred since the adverse events are not any higher than iron sucrose.
• But initial test dose is necessary before giving full desired dose for iron dextran

REFERENCES

1. www.uptodate.com
2. Product Leaflets
3. Comparative rates of adverse events with different formulations of intravenous iron, http://onlinelibrary.wiley.com/doi/10.1002/ajh.23322/full
4. Safety Issues With Intravenous Iron Products in the Management of Anemia in Chronic Kidney Disease, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670525/