Iron Sucrose (Venofer)
|
Iron Dextran (Cosmofer)
|
|
Strength
|
100mg/5ml
[Elemental Iron
= 20 MG/ML]
|
100 mg / 2 ml
[Elemental Iron = 50 MG/ML]
|
Dose Recommended
|
Adult and the
elderly:
100-200 mg iron,
1-3 times per week (depending on Hb level)
Maximum
tolerated dose (MTD)
As injection : MTD per day (max. 200mg iron) given 3
times per week
As infusion : Maximum tolerated single dose per day
(max. 500 mg) given once per week: (give each dose over at least 3.5 hours)
Patient >70 kg : 500 mg iron sucrose
Patient ≤70 kg : 7 mg iron/kg body weight
|
Adult:
100-200mg iron,
2-3x/week (depending on Hb level)
Maybe administered as a
total dose infusion up to a total replacement dose corresponding to 20mg
iron/kg bw
|
Calculation of Dose
|
Refer table 1
If the total
necessary dose exceeds the maximum allowed single dose, then the
administration has to be split (refer to “MTD” section in “DOSE” above).
|
Refer Table 2
|
Advantage
|
Test dose not required but
recommended in patient with history of
drug allergy
|
Maybe administered as a
total dose infusion up to a total replacement dose corresponding to 20mg
iron/kg bw
|
Disadvantage
|
There’s maximum tolerated dose
|
Requires test dose
|
Liver adjustment
|
No dose adjustment
|
No dose adjustment, use
with extreme caution
|
Contraindication
|
·
Hypersensitivity to the active substance,
·
Known serious hypersensitivity to other parenteral iron products
·
Anaemia not caused by iron deficiency
·
Evidence
of iron overload or hereditary disturbances in utilisation of iron.
|
·
Hypersensitivity to the active substance,
·
Known serious hypersensitivity to other parenteral iron
products.
·
Non-iron deficiency anaemia (e.g. haemolytic anaemia).
·
Iron overload or disturbances in utilisation of iron (e.g.
haemochromatosis, haemosiderosis).
·
Decompensated liver cirrhosis and hepatitis.
·
Acute or chronic infection, because parenteral iron
administration may exacerbate bacterial or viral infections.
·
Acute renal failure.
|
·
In practice, there is no
evidence that total doses above 1000mg elemental iron are clinically useful.
·
Fixed dose of 1000mg, generally
sufficient to treat anemia and provide additional storage of iron without
causing iron overload.
·
Intravenous iron results in
replenishment of iron stores with peak ferritin concentration at 7-9 days. In
our experience, HB should rise within 2-3 weeks in majority patients.
Ganzoni
formula (for iron deficiency anaemia):
Total iron deficit (mg) = Body
Weight (kg) x (Target Hb - Actual Hb; both in g/dL) x 2.4 + Depot Iron (mg)*
*Depot
|
< 35 kg (Target Hb = 13 g/dL)
|
Depot = 15 mg/kg body weight
|
≥ 35 kg (Target Hb = 15 g/dL)
|
Depot = 500 mg
|
*For blood loss, can apply the same formula but NO need to add in the depot iron.
Table 1: Venofer Dosing Table
(value in
the table denotes : number of ampoules to be administered)
|
||||||||||||||
Body Weight
(kg)
|
||||||||||||||
40
|
45
|
50
|
55
|
60
|
65
|
70
|
75
|
80
|
85
|
90
|
95
|
100
|
||
Increase in Hb Required (g/dL) #
|
1
|
6
|
6
|
6
|
6
|
6
|
7
|
7
|
7
|
7
|
7
|
7
|
7
|
7
|
2
|
7
|
7
|
7
|
8
|
8
|
8
|
8
|
9
|
9
|
9
|
9
|
10
|
10
|
|
3
|
8
|
8
|
9
|
9
|
9
|
10
|
10
|
10
|
11
|
11
|
11
|
12
|
12
|
|
4
|
9
|
9
|
10
|
10
|
11
|
11
|
12
|
12
|
13
|
13
|
14
|
14
|
15
|
|
5
|
10
|
10
|
11
|
12
|
13
|
13
|
13
|
14
|
15
|
15
|
16
|
16
|
17
|
|
6
|
11
|
11
|
12
|
13
|
14
|
14
|
15
|
16
|
17
|
17
|
18
|
19
|
19
|
|
7
|
12
|
12
|
13
|
14
|
15
|
16
|
17
|
18
|
18
|
19
|
20
|
21
|
22
|
|
# Increase in Hb Required = Target Hb
minus Actual Hb
If
given as infusion, maximum tolerated single dose (given once per week) is to be
given as follow:
Body
weight
|
Maximum
tolerated single dose of iron
|
≤70 kg
|
7
mg iron/kg body weight
|
>70 kg
|
500
mg iron sucrose
|
Please note
that this table is NOT the SAME as the one available under section of Iron
Sucrose Injection in: Injectable Drugs:
Preparation & Administartion Guide for Hospital Keningau (2nd
Edi. 2019).
Table 2: Cosmofer Dosing Table
Total number of ampoules of
CosmoFer
to be administered in
iron-deficiency anaemia:
|
||||||||||||
Body Weight
(kg)
|
||||||||||||
40
|
45
|
50
|
55
|
60
|
65
|
70
|
75
|
80
|
85
|
90
|
||
Actual Hb
(g/dL)
|
6.0
|
14
|
15
|
16
|
17
|
18
|
19
|
20
|
21
|
22
|
23
|
24
|
7.5
|
12
|
13
|
14
|
15
|
16
|
17
|
18
|
19
|
19
|
20
|
21
|
|
9.0
|
11
|
12
|
12
|
13
|
14
|
14
|
15
|
16
|
17
|
17
|
18
|
|
10.5
|
9
|
10
|
10
|
11
|
12
|
12
|
13
|
13
|
14
|
14
|
15
|
|
12.0
|
8
|
8
|
9
|
9
|
9
|
10
|
10
|
10
|
11
|
11
|
12
|
|
13.5
|
6
|
7
|
7
|
7
|
7
|
7
|
8
|
8
|
8
|
8
|
8
|
|
P/S: If the total exceeds TDI or
20 mg/kg, it is recommended to split the dose.
Please note
that this table is NOT the SAME as the one available under section of Iron Dextran
Injection in: Injectable Drugs: Preparation & Administartion Guide for
Hospital Keningau (2nd Edi. 2019).
References:
1.
Product Leaflet: Iron
Dextran (CosmoFer)
2.
Product Leaflet: Iron
Sucrose (Venofer)
3.
Product Leaflet: Iron
Sucrose (Hemofer)
4.
Product Summary from
Manufacturer: Iron Dextran (CosmoFer)
5.
Product Summary from
Manufacturer: Iron Sucrose (Venofer)
6.
Uptodate
7.
Correcting Iron
Deficiency , retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5155066/
Prepared by Nur Nabiha R.
Edited by Mohd Zulhelmy & JCK Ho
[3 April 2020]
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