Generic Name

Venofer

Mechanism

Venofer is a *water‑soluble iron complex* administered intravenously.
• Delivers free ferric iron to the bloodstream after dissociation from the sucrose chain.
• Iron is endocytosed by reticuloendothelial cells (macrophages, hepatocytes) and incorporated into *transferrin* for transport to bone marrow.
• Facilitates rapid replenishment of iron stores and stimulates erythropoiesis, correcting anemia faster than oral iron.

Pharmacokinetics

Clinical note: Renal impairment does not significantly alter pharmacokinetics, making it suitable for CKD patients.

Indications

• Iron deficiency anemia when oral iron is ineffective, intolerable, or contraindicated.
• Anemia of chronic kidney disease (CKD).
• Pre‑operative anemia in elective surgeries.
• Iron deficiency associated with inflammatory bowel disease.
• Anemia in patients with malabsorption or dietary restrictions.

Contraindications

• Contraindications:
• Known hypersensitivity to iron sucrose, sucrose, or any excipients.
• Iron overload (e.g., hereditary hemochromatosis, transfusion‑related iron overload).
• Warnings:
• Risk of volume overload → monitor fluid status.
• Anaphylactic reactions rare but possible. Use with caution in patients with a history of severe drug hypersensitivity.
• Pregnancy: Category C; use if benefits outweigh risks.
• Breastfeeding: Compatible; minimal infant exposure.

Dosing

• Adult dose: 200 mg of elemental iron (5 mL of 20 mg/mL solution) once weekly.
• ≤ 1000 mg total per cycle (maximum 5 weeks).
• Infusion rate:
• ≤ 30 mL per 10 min (≤ 6 mL/min).
• Adjust rate if hypotension, tachycardia, or flushing occurs.
• Pre‑medication:
• Antihistamine (e.g., diphenhydramine) + antipyretic (acetaminophen) for high‑risk patients.
• Special populations:
• CKD (dialysis) patients: Same dosing; may require additional infusion post‑dialysis.
• Pregnancy and lactation: Follow standard dosing; monitor fetal growth if applicable.

Adverse Effects

Serious adverse events: anaphylaxis, severe hypotension, or hypersensitivity. Treat promptly with epinephrine and supportive care.

Monitoring

• Baseline & Follow‑up labs:
• CBC (Hb, Hct).
• Serum ferritin.
• Total iron‑binding capacity (TIBC).
• Transferrin saturation (TSAT).
• Renal function (BUN, Cr).
• Infusion monitoring:
• Vital signs before, during, and 30 min after infusion.
• Post‑infusion follow‑up:
• Evaluate for delayed hypersensitivity (24–48 h).
• Iron overload assessment:
• Repeat ferritin and TSAT 4–6 weeks after last infusion.

Clinical Pearls

• Early Initiation: Start IV iron in CKD patients *before* declining Hb < 11 g/dL to avoid EPO dose escalation.
• Avoid Premedication in Low‑Risk Patients: Premedication may mask early signs of infusion reactions; reserve only for those with history of severe allergies.
• Volume Management: In heart‑failure patients, infuse over ~30 min and check diuresis status; pre‑infusion diuretics can reduce edema risk.
• Drug Interactions: Concurrent calcium or phosphate supplements can interfere with iron absorption *in vitro*—but IV iron bypasses gut, so no significant interaction.
• Patient Education: Instruct patients to report any unusual itching, flushing, or shortness of breath within 30 min of infusion.
• Record Keeping: Maintain a dose‑log (including total elemental iron) to prevent exceeding the recommended 1000 mg limit.
• Insurance & Reimbursement: Pre‑authorization often required—have lab values (ferritin < 30 ng/mL and TSAT < 20 %) ready.

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• *For detailed dosing tables, institutional protocols, or regional guidelines, consult the latest prescribing information and local formulary.*