Iron sucrose

Last updated
Iron sucrose
Iron sucrose IV drip.jpg
Clinical data
Trade names Venofer, others
AHFS/Drugs.com Monograph
MedlinePlus a614017
License data
Pregnancy
category
  • AU:B3
Routes of
administration
Intravenous
ATC code
Legal status
Legal status
Identifiers
  • disodium;(2R,3R,4S,5S,6R)-2-[(2S,3S,4S,5R)-3,4-dihydroxy-2,5-bis(hydroxymethyl)oxolan-2-yl]oxy-6-(hydroxymethyl)oxane-3,4,5-triol;iron(3+);oxygen(2-);hydroxide;trihydrate
CAS Number
PubChem CID
DrugBank
UNII
KEGG
ChEBI
ChEMBL
Chemical and physical data
Formula C12H29Fe5Na2O23
Molar mass 866.546 g·mol−1
3D model (JSmol)
  • C(C1C(C(C(C(O1)OC2(C(C(C(O2)CO)O)O)CO)O)O)O)O.O.O.O.[OH-].[O-2].[O-2].[O-2].[O-2].[O-2].[O-2].[O-2].[O-2].[Na+].[Na+].[Fe+3].[Fe+3].[Fe+3].[Fe+3].[Fe+3]
  • InChI=1S/C12H22O11.5Fe.2Na.4H2O.8O/c13-1-4-6(16)8(18)9(19)11(21-4)23-12(3-15)10(20)7(17)5(2-14)22-12;;;;;;;;;;;;;;;;;;;/h4-11,13-20H,1-3H2;;;;;;;;4*1H2;;;;;;;;/q;5*+3;2*+1;;;;;8*-2/p-1/t4-,5-,6-,7-,8+,9-,10+,11-,12+;;;;;;;;;;;;;;;;;;;/m1.................../s1
  • Key:FWZTTZUKDVJDCM-CEJAUHOTSA-M

Intravenous iron sucrose is a commonly used treatment for iron deficiency anemia. Iron sucrose replaces iron in the blood to foster red blood cell production in patients with chronic kidney disease. Iron sucrose has the trade name Venofer. [1]

Contents

Chemical structure

The chemical formula of iron sucrose is C12H29Fe5Na2O23. The iron sucrose molecule is a polymer with two main molecules; sucrose (chemical formula C12H22O11) and an iron (III) hydroxide (Na2Fe5O8•3(H2O)). These two components are in solution together, but are not bound to one another. [2] Iron sucrose is a type II complex, with two oxygen atoms bonded to each iron atom. [3] When used for medicinal purposes, the iron complex is polymerized and the sucrose molecules combined to form a larger polysaccharide. The number of polymerizations does not have to be the same as the number of sucrose molecules in the polysaccharide.[ citation needed ]

Structure of iron sucrose. Sucrose molecule is black, and iron complex and ions in solution are red. Iron Sucrose Structure.jpg
Structure of iron sucrose. Sucrose molecule is black, and iron complex and ions in solution are red.

History

Iron sucrose's first known use was in Europe in 1949, [4] but it was not used in US medicine until November 2000. [3] It replaced iron dextran, which had been in use in the US since the 1900s, as a treatment for iron deficiency. Iron dextran was only used for extremely high risk situations, because it released enough iron at once to be toxic to the body. Further development of iron dextran was able to lower these reactions, but also caused more severe gastrointestinal problems. These compounds caused issues mostly because of their high molecular weights. Low molecular weight alternatives were eventually introduced to counter these risks. The first of these was ferric gluconate in 1999, which lowered the risk of unwanted gastrointestinal issues. Iron sucrose followed shortly after, and had an even greater effect on reducing the frequency of serious adverse side effects. [3]

Medical uses

Iron sucrose is a dark brown liquid solution. It is administered intravenously and is only used when a patient with iron deficiency cannot be treated using oral iron options. [5] It is a generally effective drug, with more than 80% of patients responding to treatment. Iron sucrose has ~20 mg of iron per mL of solution. A typical adult patient can safely receive 600 mg of iron sucrose per week, administered in separate doses of 200–300 mg. Most patients experience an increase in their hemoglobin levels of at least 20 g/L. [3] Administration usually takes from fifteen to thirty minutes [3] and is done by a medical professional. Often, normal saline solution (NSS) is mixed with the iron sucrose during injection. [6]

Once iron sucrose has been administered, it is transferred to ferritin, the normal iron storage protein. [7] Then, it is broken down in the liver, spleen, and bone marrow. The iron is then either stored for later use in the body or taken up by plasma. The plasma transfers the iron to hemoglobin, where it can begin increasing erythropoiesis (red blood cell production). [3]

Iron sucrose is most commonly used to treat iron deficiency anemia, which can be caused by chronic kidney disease. [3]

Risks and side effects

Iron sucrose can have a multitude of unintended side effects during and after administration. The following symptoms are considered serious, and a patient experiencing them should seek immediate medical attention:[ citation needed ]

Less serious symptoms, which only need to be addressed by a medical professional if they are long-lasting, include:

Dizziness and fainting during treatment is not uncommon and can be addressed during treatment by a medical professional. These symptoms are also common when the dose the patient receives is raised. [1]

Iron sucrose has also been shown to significantly lower the risk of gastrointestinal problems when compared to oral iron treatments. It has a much lower rate of serious allergic reactions in comparison to other iron substitution treatments (around 0.002% in iron sucrose in comparison to 0.04-2.3% in other treatments). In iron sucrose, there have been no reported cases of these reactions being deadly. [3]

Related Research Articles

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Anemia or anaemia is a blood disorder in which the blood has a reduced ability to carry oxygen. This can be due to a lower than normal number of red blood cells, a reduction in the amount of hemoglobin available for oxygen transport, or abnormalities in hemoglobin that impair its function.

<span class="mw-page-title-main">Iron deficiency</span> State in which a body lacks enough iron to supply its needs

Iron deficiency, or sideropenia, is the state in which a body lacks enough iron to supply its needs. Iron is present in all cells in the human body and has several vital functions, such as carrying oxygen to the tissues from the lungs as a key component of the hemoglobin protein, acting as a transport medium for electrons within the cells in the form of cytochromes, and facilitating oxygen enzyme reactions in various tissues. Too little iron can interfere with these vital functions and lead to morbidity and death.

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Iron poisoning typically occurs from ingestion of excess iron that results in acute toxicity. Mild symptoms which occur within hours include vomiting, diarrhea, abdominal pain, and drowsiness. In more severe cases, symptoms can include tachypnea, low blood pressure, seizures, or coma. If left untreated, acute iron poisoning can lead to multi-organ failure resulting in permanent organ damage or death.

<span class="mw-page-title-main">Methemoglobinemia</span> Condition of elevated methemoglobin in the blood

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<span class="mw-page-title-main">Hemolytic anemia</span> Reduced oxygen-carrying ability of the blood due to breakdown of red blood cells

Hemolytic anemia or haemolytic anaemia is a form of anemia due to hemolysis, the abnormal breakdown of red blood cells (RBCs), either in the blood vessels or elsewhere in the human body (extravascular). This most commonly occurs within the spleen, but also can occur in the reticuloendothelial system or mechanically. Hemolytic anemia accounts for 5% of all existing anemias. It has numerous possible consequences, ranging from general symptoms to life-threatening systemic effects. The general classification of hemolytic anemia is either intrinsic or extrinsic. Treatment depends on the type and cause of the hemolytic anemia.

<span class="mw-page-title-main">Iron-deficiency anemia</span> Reduced ability of the blood to carry oxygen due to a lack of iron

Iron-deficiency anemia is anemia caused by a lack of iron. Anemia is defined as a decrease in the number of red blood cells or the amount of hemoglobin in the blood. When onset is slow, symptoms are often vague such as feeling tired, weak, short of breath, or having decreased ability to exercise. Anemia that comes on quickly often has more severe symptoms, including confusion, feeling like one is going to pass out or increased thirst. Anemia is typically significant before a person becomes noticeably pale. Children with iron deficiency anemia may have problems with growth and development. There may be additional symptoms depending on the underlying cause.

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Microcytic anaemia is any of several types of anemia characterized by smaller than normal red blood cells. The normal mean corpuscular volume is approximately 80–100 fL. When the MCV is <80 fL, the red cells are described as microcytic and when >100 fL, macrocytic. The MCV is the average red blood cell size.

<span class="mw-page-title-main">Iron supplement</span> Iron formulation used to prevent or treat iron deficiency anemia

Iron supplements, also known as iron salts and iron pills, are a number of iron formulations used to treat and prevent iron deficiency including iron deficiency anemia. For prevention they are only recommended in those with poor absorption, heavy menstrual periods, pregnancy, hemodialysis, or a diet low in iron. Prevention may also be used in low birth weight babies. They are taken by mouth, injection into a vein, or injection into a muscle. While benefits may be seen in days, up to two months may be required until iron levels return to normal.

<span class="mw-page-title-main">Sucrose intolerance</span> Medical condition

Sucrose intolerance or genetic sucrase-isomaltase deficiency (GSID) is the condition in which sucrase-isomaltase, an enzyme needed for proper metabolism of sucrose (sugar) and starch, is not produced or the enzyme produced is either partially functional or non-functional in the small intestine. All GSID patients lack fully functional sucrase, while the isomaltase activity can vary from minimal functionality to almost normal activity. The presence of residual isomaltase activity may explain why some GSID patients are better able to tolerate starch in their diet than others with GSID.

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Intravenous (IV) iron infusion is a therapy in which a combination of iron and saline solution is delivered directly into the bloodstream through a vein, in patients suffering iron deficiency, iron-deficiency anaemia and chronic kidney disease. IV iron infusions are recommended when oral iron supplementation fails to adequately restore iron and haemoglobin levels in the blood. The intravenous method is a fast and effective way of delivering iron throughout the body, used as iron can be administered instantly rather than gradually over time.

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References

  1. 1 2 "Iron Sucrose (Intravenous Route) Description and Brand Names". Mayo Clinic. Retrieved 2019-05-05.
  2. "Sucroferric oxyhydroxide". PubChem. National Center for Biotechnology Information, U.S. National Library of Medicine. Retrieved 2019-05-05.
  3. 1 2 3 4 5 6 7 8 Cançado RD, Muñoz M (2011). "Intravenous iron therapy: how far have we come?". Revista Brasileira de Hematologia e Hemoterapia. 33 (6): 461–9. doi:10.5581/1516-8484.20110123 (inactive 2024-04-26). PMC   3459360 . PMID   23049364.{{cite journal}}: CS1 maint: DOI inactive as of April 2024 (link)
  4. Auerbach M, Ballard H (2010-12-04). "Clinical use of intravenous iron: administration, efficacy, and safety". Hematology. American Society of Hematology. Education Program. 2010 (1): 338–47. doi: 10.1182/asheducation-2010.1.338 . PMID   21239816.
  5. "Protocol for the use of Intravenous Iron Sucrose (Venofer ) - PDF". docplayer.net. Retrieved 2019-05-23.
  6. "iron sucrose (injection)". Michigan Medicine. University of Michigan. Retrieved 2019-05-05.
  7. Yee J, Besarab A (December 2002). "Iron sucrose: the oldest iron therapy becomes new". American Journal of Kidney Diseases. 40 (6): 1111–21. doi:10.1053/ajkd.2002.36853. PMID   12460028.
  8. "Iron Sucrose (Intravenous Route) Side Effects". Mayo Clinic. Retrieved 2019-05-05.