Pharmacology · Antianaemia agents (iron, folic acid, vitamin B12)

Iron sucrose !

Intravenous iron used mainly in chronic kidney disease, often with an ESA. Patients are watched for allergic reactions during and after each dose.

Updated 2026-11-01

Class: Antianaemia agents (iron, folic acid, vitamin B12)
Target: Transferrin, the plasma iron carrier (iron is built into haemoglobin)
ATC code: B03AC

Also called: iron(III) hydroxide sucrose complex

Transferrin, the plasma iron carrier (iron is built into haemoglobin)Iron sucrose

The figure shows human serum transferrin carrying two ferric iron ions; replacement iron travels in the blood this way to the marrow.

Target in 3D: Transferrin, the plasma iron carrier (iron is built into haemoglobin). PDB structure 3QYT (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Iron sucrose is a complex of iron(III) hydroxide in sucrose. After intravenous injection the reticuloendothelial system takes it up and splits off the iron, which joins transferrin and ferritin and is used by the marrow. It bypasses gut absorption, so it works when oral iron fails, is not tolerated or is blocked by inflammation.

Iron is absorbed or released into the blood
Transferrin carries it to the bone marrow
Red cell precursors build it into haem
Haemoglobin rises and stores (ferritin) refill

Pharmacokinetics

Distribution: Taken up by the reticuloendothelial system (liver, spleen, marrow)

Indications

Iron-deficiency anaemia in chronic kidney disease, including patients on dialysis and on ESAs Chronic kidney disease →
Iron deficiency when oral iron fails or is not tolerated Iron deficiency anaemia →

Adverse effects

Common

Headache, dizziness
Nausea, abdominal pain, constipation or diarrhoea
Muscle cramps
Taste changes
Injection-site reactions

Contraindications

Previous severe allergic reaction to iron sucrose
Anaemia not caused by iron deficiency

Key interactions

Erythropoiesis-stimulating agents (epoetin alfa, darbepoetin alfa): Often combined in kidney disease: ESAs work poorly unless iron stores are adequate

What is monitored

Haemoglobin, ferritin and transferrin saturation
Blood pressure and signs of allergy during the dose and for at least 30 minutes afterwards

Administration and safety

Intravenous only: slow injection or diluted infusion
Resuscitation equipment available; the infusion is slowed or stopped if a reaction occurs

Nursing care

Observe the patient during and for at least 30 minutes after each dose
Check blood pressure; dizziness can signal hypotension
Check the access site for leakage

Pregnancy and breastfeeding

It can be used in pregnancy when oral iron is not enough; single-dose intravenous products may be preferred because fewer infusions are needed.

Test yourself

Think of the answer, then tap the question to see it.

In which disease is iron sucrose mainly used?

Chronic kidney disease, often with an ESA.

What must nurses watch for during and after the dose?

Allergic reactions and low blood pressure.

Why does intravenous iron work when oral iron fails in inflammation?

It bypasses gut absorption, which hepcidin blocks.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Iron Sucrose Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 45 (McGraw Hill, 2023); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.