iron sucrose


iron

 (Fe) [i´ern] a chemical element, atomic number 26, atomic weight 55.847. (See Appendix 6-1.) Iron is chiefly important to the human body because it is the main constituent of hemoglobin, cytochrome, and other components of respiratory enzyme systems. A constant although small intake of iron in food is needed to replace erythrocytes that are destroyed in the body processes. Most iron reaches the body in food, where it occurs naturally in the form of iron compounds. These are converted for use in the body by the action of the hydrochloric acid produced in the stomach. This acid separates the iron from the food and combines with it in a form that is readily assimilable by the body. Vitamin C enhances absorption of iron, and alkalis hamper absorption.Iron Deficiencies. The amount of new iron needed every day by the adult body is about 18 mg. A child needs more in proportion to weight. Although these amounts are very small, iron deficiencies may cause serious disorders. Three stages of iron deficiency are distinguished: iron depletion or prelatent iron deficiency, in which bodily stores are mildly depleted but no change in hematocrit or serum iron levels is detectable; latent iron deficiency, in which the serum iron level has dropped but the hematocrit is unchanged and there is no anemia; and anemia" >iron deficiency anemia, a serious condition characterized by low to absent iron stores, low hematocrit, and other blood abnormalities. A great loss of blood, such as may result from bleeding ulcers, hemorrhoids, or injury, is the most common cause of a deficiency of iron. Women who lose much blood in menstruation may have to supplement their diet with iron-rich food. Iron deficiency sometimes occurs in pregnancy as a result of increased demands on the mother's blood. It may also occur in infants, since milk contains little iron. Although babies are born with an extra supply of hemoglobin, by the age of 2 or 3 months they need iron-rich food to supplement milk.
Iron preparations, such as ferrous sulfate, may be necessary in the treatment of iron deficiency anemia; they should be administered after meals, never on an empty stomach. The patient should be warned that the drugs cause stools to turn dark green or black. Overdosage may cause severe systemic reactions.
An acute iron deficiency may warrant parenteral administration of an iron supplement. Hypersensitivity to iron supplements often occurs in patients with other known allergies. In other patients the parenteral administration of iron can cause vomiting, chills, fever, headache, joint pain, and urticaria.Food Sources of Iron. Liver is the richest source of iron; 200 g (6 ounces) of liver contains a whole day's supply for an adult. Other iron-rich foods include lean meat, oysters, kidney beans, whole wheat bread, kale, spinach, egg yolk, turnip greens, beet greens, carrots, apricots, and raisins.Iron metabolism. Uptake of heme iron or ferrous iron occurs in the intestine. From the intestine, iron is transported on transferrin to the liver or the bone marrow. Transferrin binds to red blood precursors in the bone marrow and delivers iron for incorporation into hemoglobin. Red blood cells in the circulation contain 60 percent to 80 percent of body iron. Old red blood cels are destroyed in the spleen. The iron is bound to transferrin for recirculation. Approximately 20 percent to 30 percent of iron is stored in the form of hemosiderin in the spleen, liver, and bone marrow. The remaining iron is in the respiratory enzymes of somatic cells. Iron is lost by desquamation of skin and intestinal cells. From Damjanov, 2000.iron 59 a radioisotope of iron having a half-life of 44.5 days; used in ferrokinetics tests to determine the rate at which iron is cleared from the plasma and incorporated in red blood cells. Symbol 59Fe.iron dextran a complex of iron and dextran of low molecular weight; administered intravenously or intramuscularly as a hematinic.iron poisoning poisoning from ingestion of excessive iron or iron-containing compounds, such as in children who eat iron supplement tablets like candy; symptoms include ulceration of the gastrointestinal tract, vomiting, vasodilation with shock, metabolic acidosis, liver injury, and coagulation disturbances.iron storage disease hemochromatosis.iron sucrose a complex of ferric hydroxide, Fe(OH)3, in sucrose; used intravenously to treat anemia" >iron deficiency anemia in hemodialysis patients receiving supplemental erythropoietin therapy.

iron sucrose

Venofer

Pharmacologic class: Trace element

Therapeutic class: Iron supplement

Pregnancy risk category B

Action

Replenishes depleted stores of iron (a component of hemoglobin) in bone marrow

Availability

Aqueous complex for injection: 20 mg elemental iron/ml in 5-ml single-use vials (100 mg of elemental iron)

Indications and dosages

➣ Iron-deficiency anemia in hemodialysis patients concurrently receiving erythropoietin

Adults: 100 mg of elemental iron (5 ml) I.V. directly into dialysis line or by slow injection or infusion during dialysis session (up to three times weekly) for 10 doses (total of 1,000 mg)

Off-label uses

• Autologous blood donation

• Bloodless surgery

Contraindications

• Hypersensitivity to drug, alcohol, tartrazine, or sulfites

• Hemolytic anemias and other anemias not caused by iron deficiency

• Primary hemochromatosis

Precautions

Use cautiously in:

• autoimmune disorders, arthritis, severe hepatic impairment

• elderly patients

• breastfeeding patients

• children.

Administration

• Give test dose only if ordered: 50 mg (2.5 ml) I.V. over 3 to 10 minutes.

• Dilute 100 mg of elemental iron in no more than 100 ml of normal saline solution; infuse slowly I.V. over at least 15 minutes.

• Administer I.V. directly into dialysis line or by infusion at 20 mg/minute, not to exceed 100 mg/injection.

• Don't give with oral iron preparations.

Adverse reactions

CNS: dizziness, headache, syncope, seizures

CV: chest pain, tachycardia, hypotension

GI: nausea, vomiting

Hematologic: hemochromatosis, hemolysis, hemosiderosis

Musculoskeletal: muscle cramps, aches, or weakness; joint pain

Respiratory: dyspnea

Other: abnormal or metallic taste, tooth discoloration, fever, lymphadenopathy, allergic reactions including anaphylaxis

Interactions

None significant

Patient monitoring

See Monitor for hypersensitivity reaction. Keep epinephrine and other emergency supplies available in case reaction occurs.

• Assess hemoglobin, hematocrit, serum ferritin, and transferrin saturation levels before, during, and after therapy.

See Monitor blood pressure. Stay alert for hypotension.

• Watch for signs and symptoms of iron overload, such as decreased activity, sedation, and GI or respiratory tract bleeding.

Patient teaching

• Caution patient not to take oral iron preparations or vitamin supplements containing iron during therapy.

• Instruct patient to report dyspnea, itching, or rash.

• Tell patient he'll undergo periodic blood testing to monitor his response to therapy.

• As appropriate, review all other significant and life-threatening adverse reactions mentioned above.

iron sucrose

(eye-ern su-krose) ironsucrose,

Venofer

(trade name)

Classification

Therapeutic: antianemics
Pharmacologic: iron supplements
Pregnancy Category: B

Indications

Treatment of iron deficiency anemia in chronic renal failure with or without concurrent erythropoetin therapy.Treatment of iron deficiency in patients undergoing chronic hemodialysis or peritoneal dialysis who are concurrently receiving erythropoietin.

Action

Enters the bloodstream and is transported to the organs of the reticuloendothelial system (liver, spleen, bone marrow) where it becomes separated from the sucrose complex and becomes part of iron stores.

Therapeutic effects

Resolution of iron deficiency anemia associated with chronic renal failure.

Pharmacokinetics

Absorption: Following IV administration, the uptake of iron by the reticuloendothelial system is constant at about 40–60 mg/hr. Following IM doses, 60% is absorbed after 3 days; 90% after 1–3 weeks, the balance is absorbed slowly over months.Distribution: Taken up by the reticuloendothelial system.Metabolism and Excretion: Most sucrose is eliminated in urine. Most of the iron remains stored and used on demand. Small amounts eliminated in urine.Half-life: 6 hr.

Time/action profile (effects on erythropoesis )

ROUTEONSETPEAKDURATION
IVdays1–2 wkwks–mos

Contraindications/Precautions

Contraindicated in: Anemia not due to iron deficiency; Hemochromatosis, hemosiderosis, or other evidence of iron overload; Hypersensitivity to iron sucrose.Use Cautiously in: Any evidence of tissue iron overload; Obstetric / Use only if clearly needed. Lactation: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • headache (most frequent)
  • dizziness
  • weakness

Respiratory

  • cough
  • dyspnea

Cardiovascular

  • hypotension
  • chest pain
  • HF
  • hypertension

Gastrointestinal

  • diarrhea (most frequent)
  • nausea (most frequent)
  • vomiting (most frequent)
  • abdominal pain
  • ↑ liver enzymes
  • taste perversion

Dermatologic

  • pruritus

Fluid and Electrolyte

  • hypervolemia

Local

  • injection site reactions

Musculoskeletal

  • leg cramps (most frequent)
  • musculoskeletal pain

Miscellaneous

  • hypersensitivity reactions including ANAPHYLACTIC SHOCK (life-threatening)
  • fever
  • pain
  • sepsis

Interactions

Drug-Drug interaction

Chloramphenicol and vitamin E may ↓ hematologic response to iron therapy.

Route/Dosage

Intravenous (Adults) Dialysis dependent patients—100 mg (5 mL) during each dialysis session for 10 doses (total of 1000 mg) additional smaller doses may be necessary; Non-dialysis dependent patients—200 mg (10 mL) on 5 different days within a 14 day period to a total of 1000 mg, may also be given as infusion of 500 mg on day 1 and day 14; Peritoneal Dialysis patients- administered in a total cumulative dose of 1000 mg in 3 divided doses, 14 days apart within a 28 day period with first 2 doses of300 mg and third dose of 400 mg.

Availability

Aqueous complex for injection: 20 mg/mL

Nursing implications

Nursing assessment

  • Monitor BP during infusion. May cause hypotension; usually related to rate of administration and total dose administered.
  • Assess for hypersensitivity reactions and anaphylaxis (rash, dyspnea, loss of consciousness, hypotension, collapse, convulsions) for at least 30 min following injection. Equipment for resuscitation should be readily available.
  • Lab Test Considerations: Monitor hemoglobin, hematocrit, serum ferritin, and transferritin saturation prior to and periodically during therapy. Transferrin saturation values ↑ rapidly after IV administration; therefore, serum iron values may be reliably obtained 48 hr after IV administration. Withhold iron therapy if evidence of iron overload occurs.
    • May cause ↑ liver enzymes.
    • Symptoms of iron overdose or too rapid infusion are hypotension, headache, vomiting, nausea, dizziness, joint aches, paresthesia, abdominal and muscle pain, edema, and cardiovascular collapse. Treatment includes IV fluids, corticosteroids, and/or antihistamines. Administering at a slower rate usually relieves symptoms.

Potential Nursing Diagnoses

Activity intolerance (Indications)

Implementation

  • Do not administer iron sucrose concurrently with oral iron, as the absorption of oral iron is reduced. Each 5 mL vial contains 100 mg of elemental iron.
    • Test dose of 50 mg may be used.
    • Solution is brown. Inspect for particulate matter or discoloration. Do not administer solutions that contain particulate matter or are discolored.
    • Pediatric: Exercise caution when administering and calculating doses; overdosage can be fatal.
  • Intravenous Administration
  • pH: 10.5–11.1.
    • Hemodialysis Dependent Patients:
  • Most patients require a minimum cumulative dose of 1000 mg of elemental iron, administered over 10 sequential dialysis sessions, to achieve a favorable hemoglobin or hematocrit response.
  • May be administered undiluted by slow injection into dialysis line.
  • Rate: Administer undiluted solution at a rate of 100 mg over 2–5 min, not to exceed one vial per injection. Discard any unused portion.
    • Peritoneal Dialysis Patients
  • Intermittent Infusion: For Peritoneal Dialysis Patients-Diluent: Dilute each dose in a maximum of 250 mL of 0.9% NaCl.
  • Rate: Administer doses of 300 mg over 1.5 hrs and doses of 400 mg over 2.5 hrs.
  • Intermittent Infusion: May also be administered via infusion, into dialysis line for hemodialysis patients. May reduce risk of hypotensive episodes. Each vial must be diluted in a maximum of 100 mL of 0.9% NaCl immediately prior to infusion. Discard unused diluted solution.
  • Rate: Infuse at a rate of 100 mg of iron over at least 15 min.
    • Non-dialysis Dependent Patients:
  • May be administered as a slow injection of 200 mg undiluted.
  • Rate: Administer over 2–5 min.
  • Intermittent Infusion: Dilute 500 mg in 250 mL 0.9% NaCl.
  • Rate: Infuse over 3.5–4 hr on days 1 and 14. May cause hypotension; monitor closely.
  • Additive Incompatibility: Iron sucrose should not be admixed with any other medications or parenteral nutrition solutions.

Patient/Family Teaching

  • Explain purpose of iron therapy to patient.
  • Instruct patient to report symptoms of hypersensitivity reaction to health care professional immediately.

Evaluation/Desired Outcomes

  • Improvement in anemia of chronic renal failure.