Total iron deficit [mg] = body weight [kg] x (target Hb-actual Hb) [g/dl] x 2.

4 +
depot iron [mg]
Where, mg for depot iron:
BW <35kg, estimate the iron stores using the calculation 15mg/kg
BW ≥35kg, use 500mg of iron-body stores.

IRON (III) HYDROXIDE SUCROSE COMPLEX

(VENOFER®) { Preparation available 100mg/ 5ml } Venofer: Cannot give intramuscularly

• Slow IV

– Test dose of 20mg over 1-2 minutes

– 100-200mg per dose up to 3 times per week

– Doses must be 24 hours apart

– Administered undiluted

– Rate of 1mL (20mg) in at least one minute.

• IV Infusion

– Maximum single tolerated dose is 7mg/kg (up to 500mg per week)

– Dilute with NS to a final conc. of 1mg/mL

– Run the first 20mg over 15 minutes (Test dose)

Dose Infusion Time

100 mg 15 min
200 mg 30 min
300 mg 90 min
400 mg 150 min
500 mg (max) 210 min
Worked example

 A 40kg woman with Hb of 8g/dL requires Hb of 11g/dL.

 Using the formula, the total iron dose is calculated as:
[10 x (11-8) x (0.24x40)] + 500 = 788mg.

 788 mg iron exceed the maximum dose per week (500mg)

 to give in split dose : 200mg, 200mg, 100mg
 Dilute 400mg (4 ampoules) in 400ml NS, run 20mg (20ml) over 15 minutes, then remaining 380ml
(380mg) for 90 minutes

Label patient:
Test dose: 20mg (1ml) at least 1
minutes, then continue remaining
__mg (__ml) in ___ml Ns run over
__ hour

Label patient:
Test dose: Dilute ___mg in ___ml
NS, run 20mg (20ml) over 15
minutes, then remaining ___mg
(__ml) for ___minutes
IRON DEXTRAN
(COSMOFER®) – {Preparation available: 100mg/2mL } Cosmofer: Can give intramascularly

• IV Infusion: Deep IM Slow IV

 Up to 100mg iron (undiluted)  100mg OD or 200mg up to 3 times a

 If patient is moderately active, week
may be given daily into  Dilute 100-200mg in 10-20mL diluent
alternative buttocks. (NS, D5)
 If inactive or bedridden,  Test dose of 25mg given over 1-2
decrease frequency to once or minutes.
twice weekly.  Slow IV at rate of 10mg/min

– 100-200mg per dose diluted in 100mL diluent.

– Test dose of 25mg over 15 minutes should be administered on every occasion.

– Infuse remaining over 30 minutes.

• Total Dose Infusion:

– Up to 20mg/kg iron Max dose per day: 20mg/kg/day

Max dose per week: 1000mg
– Dilute usually to 500mL diluent

– Infuse over 4-6 hours

• 50mLs/hr for the first hour (if rate of test dose is > 50mL/hr continue first hour at
test dose rate)

• 100mL/hr for the next hour

• 150mL/hr until infusion complete

Label patient: Eg- Dose 500mg

Test dose: 25mg (0.5ml) in 20ml NS
run over 15 min. Continue 475mg
in 250ml Ns run over 3 hour

Worked example
 A 50kg woman with Hb of 5g/dL requires Hb of 11g/dL.
 Using the formula, the total iron dose is calculated as:
[10 x (11-5) x (0.24x50)] + 500 = 1220mg.

 Round up, she requires 1200mg iron.

 The dose in mg/kg is 24mg/kg which cannot be given in a single infusion, given that it exceeds the 20mg/kg
maximum.
 A dose of 1000mg (20mg/kg) is infused as 20mL of CosmoFer® in 500mL of sodium chloride 0.9% or
dextrose 5% over 4-6 hours (after monitoring and checking that she tolerates 25mg (12.5mL) over 15
minutes first).
 A week later, the remaining portion, 200mg, is infused as 4mL of CosmoFer® in 500mL of sodium chloride
0.9% or dextrose 5% over 4-6 hours (after monitoring and checking that she tolerates 25mg (12.5mL) over 15
minutes first).
Note: there is also an option of administering the second portion as a 100-200mg iron (2-4mL) by slow
intravenous injection.