This information is not individual medical advice and does not substitute for the advice of your health care professional. iron sucrose decreases levels of liothyronine by inhibition of GI absorption. This medicine is sometimes given slowly, and the infusion can take up to 2.5 hours to complete. This may be helped by giving the medication more slowly or at a lower dose. Separate by 2 hr. Avoid or Use Alternate Drug. Use Caution/Monitor. Canada residents can call a provincial poison control center. Untreated IDA in pregnancy is associated with adverse maternal outcomes such as post-partum anemia. In key trials, ferric carboxymaltose increased Hb levels and replenished iron stores as effectively as IV iron sucrose . After total replacement dose completed, need for ongoing IV doses should be re-assessed monthly. Serious - Use Alternative (1)iron sucrose decreases levels of levofloxacin by inhibition of GI absorption. For iron maintenance treatment: Administer Venofer at a dose of 0.5 mg/kg, not to exceed 100 mg per dose, every four weeks for 12 weeks given undiluted by slow intravenous injection over 5 minutes or diluted in 0.9% NaCl at a concentration of 1 to 2 mg/mL and administered over 5 to 60 minutes. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. Brand name: Venofer Drug class: Iron Preparations Chemical name: iron saccharate CAS number: 8047-67-4 Medically reviewed by Drugs.com on Oct 25, 2022. Either increases effects of the other by pharmacodynamic synergism. Koch TA, Myers J, Goodnough LT. Intravenous Iron Therapy in Patients with Iron Deficiency Anemia: Dosing Considerations. Minor/Significance Unknown. calcium acetate decreases levels of iron sucrose by inhibition of GI absorption. Calculosaurus | Ferinject dose calculator Avoid or Use Alternate Drug. FERAHEME Dosing & Administration - Feraheme 1 ,*. iron sucrose decreases levels of thyroid desiccated by inhibition of GI absorption. 1998 Feb;25(1):65-8. Applies only to oral form of both agents. Ren Fail. The dosage of Venofer is expressed in mg of elemental iron. Data from Ferrlecit postmarketing spontaneous reports indicate that individual doses exceeding 125 mg may be associated with a higher incidence and/or severity of adverse events. Formula for calculating the required dose of iron sucrose Do not dilute to concentrations below 1 mg/mL [see How Supplied/Storage and Handling (16.2).] Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Ferrlecit has been administered at sequential dialysis sessions by infusion or by slow intravenous injection during the dialysis session itself. Applies only to oral form of both agents. Use Caution/Monitor. Contraindicated. Use Caution/Monitor. No data are available regarding overdosage of Venofer in humans. Challenges in the treatment of iron deficiency include finding and addressing the underlying cause and the selection of an iron replacement product that meets the needs of the patient. Applies only to oral form of both agents. Minor/Significance Unknown. Administer Venofer early during the dialysis session (generally within the first hour). Use Caution/Monitor. Administer on 5 different occasions over a 14 day period. 4. WARNING: RISK FOR SERIOUS HYPERSENSITIVITY/ANAPHYLAXIS REACTIONS Fatal and serious hypersensitivity reactions including anaphylaxis have occurred in patients receiving Feraheme. Applies only to oral form of both agents. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. Copyright 2014 - 2023 The Calculator .CO |All Rights Reserved|Terms and Conditions of Use, Parenteral Iron Replacement For Iron Deficiency Anemia Calculator, Intravenous Iron Therapy in Patients with Iron Deficiency Anemia: Dosing Considerations, Clinical use of the total dose intravenous infusion of iron dextran, When is high-dose intravenous iron repletion needed? You may report side effects to Health Canada at 1-866-234-2345. . Iron Deficiency Calculator - MDApp Venofer treatment may be repeated if iron deficiency reoccurs. Fatal reactions have followed the test dose of iron dextran injection. Many people using this medication do not have serious side effects.Severe dizziness or fainting (hypotension) may occur while you are receiving IV iron. Use Caution/Monitor. ADMINISTER THE TEST DOSE AT A GRADUAL RATE OVER AT LEAST 30 SECONDS. Properly discard this product when it is expired or no longer needed. During all INFeD administrations, observe for signs or symptoms of anaphylactic-type reactions. in the colostrum of 10 iron deficient breastfeeding women who were 2 to 3 days postpartum and received a single dose of 100 mg of intravenous iron . Crown Rump Length and Nuchal Translucency. Assure stable intravenous access to avoid extravasation. Intravenous iron sucrose: establishing a safe dose - PubMed famotidine will decrease the level or effect of iron sucrose by increasing gastric pH. Give each dose as 750 mg for a total cumulative dose of 1500 mg of iron per course. . Evaluate the hematologic response (hemoglobin, ferritin, iron and transferrin saturation) at least one month following the second Feraheme infusion. Applies only to oral form of both agents. Dosing Considerations (8-10) Maximum single dose of iron sucrose in all other patients is 300 mg every week. 2) Koch TA, Myers J, Goodnough LT. (2015) Intravenous Iron Therapy in Patients with Iron Deficiency Anemia: Dosing Considerations. iron sucrose decreases levels of methyldopa by inhibition of GI absorption. Monitor Closely (1)famotidine will decrease the level or effect of iron sucrose by increasing gastric pH. Administer Injectafer intravenously, either as an undiluted slow intravenous push or by infusion. Our dosage calculator can help you with this as well. Avoid or Use Alternate Drug. Minor/Significance Unknown. Use Caution/Monitor. Venofer treatment may be repeated if necessary. Prescribing and dispensing information For iron sucrose A complex of ferric hydroxide with sucrose containing 2% (20 mg/mL) of iron. Injection site discoloration has been reported following extravasation. 200-800 mg/kg (2-8 mL/kg) every 3-4 weeks. This calculator will help pinpoint potential causes of anemia based on The Ganzoni equation is: Total iron deficit (mg) = Weight in kg x (Target Hb - Actual Hb in g/dL) x 2.4 + Iron stores In most cases, adult patients require a cumulative dose of elemental iron of at least 1 g. Most commonly, iron replenishment therapy is done intravenously: As total dose (iron-dextran or iron - carboxymaltose); Maximum recommended single dose: 300 mg (See Prescriber's Orders). Indicated for treatment of iron deficiency anemia associated with chronic kidney disease, Hemodialysis-dependent CKD: 100 mg elemental iron IV (injection or infusion over 2-5 min) per dialysis session not to exceed total cumulative dose of 1000 mg divided in 3 doses/week, Non-dialysis-dependent CKD: 200 mg IV injection for 5 doses in over 14 days (cumulative 1000 mg in 14-day period), Peritoneal dialysis-dependent CKD: 300 mg IV infusion (1.5 hr) for 2 doses 14 days apart, THEN 400 mg IV infusion (2.5 hr) 14 days later (cumulative 1000 mg divided in 3 doses/week), Indicated for maintenance treatment of iron-deficient anemia associated with chronic kidney disease, <2 years: Safety and efficacy not established, Iron replacement treatment in pediatric patients has not been established. Diluted with 0.9% Sodium Chloride Injection at concentrations of 1 to 2 mg/mL, 2 doses of 300 mg/250 mL over 1.5 hrsplus1 dose of 400 mg/250 mL over 2.5 hrs. Each costs about $0.46 to $0.55 per mg of iron. Monitor Closely (1)iron sucrose will decrease the level or effect of sarecycline by inhibition of GI absorption. Schweiz Med Wochenschr; 100(7):301-3. The total amount of INFeD in mL required to treat the anemia and replenish iron stores may be approximated as follows: Adults and Children over 15 kg (33 lbs): See Dosage Table. Venofer (iron sucrose injection, USP) is a brown, sterile, aqueous, complex of polynuclear iron (III)- . Monitor Closely (1)ibuprofen/famotidine will decrease the level or effect of iron sucrose by increasing gastric pH. Due Date form Ultrasound Report. Avoid or Use Alternate Drug. iron sucrose decreases levels of fleroxacin by inhibition of GI absorption. Minor (1)iron sucrose, benazepril. Applies only to oral form of both agents. J Lab Clin Med; 111(5):566-70. Am J Hosp Pharm. Interaction only with oral iron administration. Modify Therapy/Monitor Closely. A: Generally acceptable. . In post-marketing safety studies of Venofer in 1,051 patients with HDD-CKD, adverse reactions reported by >1% were cardiac failure congestive, sepsis and dysgeusia. Pain, swelling, or redness at the injection site may occur. Use Caution/Monitor. This document does not contain all possible drug interactions. Equations used: 1] Calculation of the Total Iron Deficit: Total iron deficit [mg] = body weight [kg] x (target Hb-actual Hb) [g/dl] x 2.4 + depot iron [mg]. Iron sucrose can also be mixed in a saline solution and given through an IV over a longer time. Your doctor will do laboratory tests to monitor your response. Uses for Iron Sucrose Anemia; 2015: 763576. Only administer Venofer when personnel and therapies are immediately available for the treatment of serious hypersensitivity reactions. 2.1 Dosage - Total dose infusion The dose calculation for CosmoFer is based on patients body weight according to the table below and is diluted in 500mLs of normal saline. The iron deficit calculator is useful as one of the determinations performed before iron replenishment therapy is initiated. Monitor Closely (1)sodium citrate/citric acid will decrease the level or effect of iron sucrose by increasing gastric pH. Iron Deficit - Multi-Calc - GlobalRPH - Medical Calculators, Clinicians In case a pediatric patient with a weight below 35 kg is assessed, iron stores are calculated as 15 mg iron for each kg. Use Caution/Monitor. Last updated on Jun 1, 2022. INFeD is given undiluted at a slow gradual rate not to exceed 50 mg (1 mL) per minute. Avoid or Use Alternate Drug. All adult and pediatric patients receiving Venofer require periodic monitoring of hematologic and iron parameters (hemoglobin, hematocrit, serum ferritin and transferrin saturation). Patients may present with shock, clinically significant hypotension, loss of consciousness and/or collapse. Applies only to oral form of both agents. Monitor Closely (1)vonoprazan will decrease the level or effect of iron sucrose by inhibition of GI absorption. It is usually given slowly over 2 to 5 minutes or as directed by your doctor. elemental iron (mg/ml) in the product being used: Where C= Applies only to oral form of both agents. You are encouraged to report Adverse Drug Events to American Regent, Inc. at 1-800-734-9236 or to the FDA by visiting www.fda.gov/medwatch or calling 1-800-FDA-1088. Applies only to oral form of both agents. iron sucrose decreases levels of eltrombopag by inhibition of GI absorption. Applies only to oral form of both agents. These adverse reactions have occurred up to 30 minutes after the administration of Venofer injection. Minor/Significance Unknown.iron sucrose increases levels of calcium citrate by enhancing GI absorption. Minor (1)gymnema decreases levels of iron sucrose by inhibition of GI absorption. DICP. Can't find what you need? Applies only to oral form of both agents. If we don't have the calculator you need then tell us the details and we'll make it for you. however iron sucrose requires multiple small intermittent doses over days to weeks. On the other hand, slow decreases, such as that in chronic occult gastrointestinal bleeding are often difficult to diagnose. Avoid or Use Alternate Drug. The dosing for iron replacement treatment in pediatric patients with hemodialysis-dependent chronic kidney disease (HDD-CKD), non-dialysis-dependent chronic kidney disease (NDD-CKD) or peritoneal-dialysis-dependent chronic kidney disease (PDD-CKD) has not been established. Applies only to oral form of both agents. Serious - Use Alternative (1)iron sucrose decreases levels of doxycycline by inhibition of GI absorption. Reactions have occurred following the first dose or subsequent doses of Venofer. prescription products. Copyright(c) 2023 First Databank, Inc. NOTES: Lab and/or medical tests (such as complete blood count, ferritin, transferrin, total iron binding capacity-TIBC) should be done while you are using this medication. Applies only to oral form of both agents. Feraheme does not contain antimicrobial preservatives. Coadministration of ciprofloxacin with multivalent cation-containing products may reduce the bioavailability of ciprofloxacin by 90%. Most When administering as a slow intravenous push, give at the rate of approximately 100 mg (2 mL) per minute. Hanson DB, Hendeles L. Guide to total dose intravenous iron dextran therapy. Ferrlecit may be diluted in 100 mL of 0.9% sodium chloride administered by intravenous infusion over 1 hour per dialysis session. The above information is provided for general Fulminant symptoms may include general paleness, confusion or episodes of passing out. This site contains information for licensed healthcare professionals in the United States. Privacy Policy, Use 500 mg for adults and children 35 kg; use 15 mg/kg if <35 kg. Each mL contains 20 mg of elemental iron. OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Next Steps Evidence Creator Insights Dr. Andreas M. Ganzoni About the Creator Administer a test INFeD dose prior to the first therapeutic dose. Oral and parenteral products - see background option for oral products. informational and educational purposes only. Minor/Significance Unknown. Methods: We reviewed the experience of our department between January, 2011 and February, 2014 with the use of intravenous iron sucrose in children 14 years of age who failed in oral iron therapy for iron deficiency anemia (IDA). Minor (2)calcium citrate decreases levels of iron sucrose by inhibition of GI absorption. Your dosage and length of treatment are based on your medical condition, age, and response to treatment. PDF PRODUCT MONOGRAPH - pdf.hres.ca * Calculators are available in UpToDate to determine ideal body weight and lean body weight. Iron Sucrose Protocol - Cmqcc Diagnosis and management of iron deficiency anaemia: a clinical update. Multiple placebo-controlled, randomized clinical trials have been conducted with IV iron in patients with New York Heart Association class II-III heart failure with an ejection fraction 45% who met criteria . Keep all medical and lab appointments. 3. Ferric gluconate: 12.5 mg/mL. feasible, Maximum total cumulative iron sucrose dose administered in 14 days is 1000 mg elemental iron. concentration of elemental iron (mg/ml) in the product being used: This calculator will help pinpoint potential causes of anemia based on an automated flowchart approach. vonoprazan will decrease the level or effect of iron sucrose by inhibition of GI absorption. Applies only to oral form of both agents. Calculates iron deficit for dosing iron. Observed Hb = the patients current hemoglobin in g/dl. This site complies with the HONcode standard for trust- worthy health information: verify here. 1988 May;111(5):566-70. Applies only to oral form of both agents. In less advanced cases of iron deficiency, increases in dietary intake of iron may be sufficient. DOSAGE AND ADMINISTRATION: Oral iron should be discontinued prior to administration of INFeD. Administer iron products at least 2 hr before and no less than 6 hr after each dose to avoid chelation with magnesium. Applies only to oral form of both agents. Use Caution/Monitor. Serious - Use Alternative (1)iron sucrose decreases levels of demeclocycline by inhibition of GI absorption. In: Koda-Kimble & Young's Applied Therapeutics: The Clinical Use of Drugs. Iron deficiency anemia calculator (diagnosis), Iron deficiency anemia vs. Inspect parenteral drug products visually for the absence of particulate matter and discoloration prior to administration. J Lab Clin Med. All Rights Reserved. Where C= concentration of Monitor for signs and symptoms of hypotension following each Feraheme infusion. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: vitamin products, other iron-containing products. PDF Iron Sucrose: Guidelines for Administration Document Type: Guideline *Repeat dose if iron deficiency anemia reoccurs. Applies only to oral form of both agents. Iron sucrose: 20 mg/mL. iron sucrose decreases levels of minocycline by inhibition of GI absorption. Venofer Injection Dosage Guide - Drugs.com Dose administration to an elderly patient should be cautious, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy. esomeprazole will decrease the level or effect of iron sucrose by increasing gastric pH. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=abacb7fa-2fc2-471e-9200-944eeac8ca2a. Serious - Use Alternative (1)iron sucrose decreases levels of tetracycline by inhibition of GI absorption. )If you are using this medication at home, learn all preparation and usage instructions from your health care professional. Total dose iron infusion: safety and efficacy in predialysis patients. Applies only to oral form of both agents. Venofer (iron sucrose) 20 mg iron / ml, solution for injection or Accessed: 4/12/2011. Injection: 50 mg/2.5 mL, 100 mg/5 mL, or 200 mg/10 mL (20 mg/mL) in single-dose vials. Where C is the concentration of the iron product: Please note that the calculations above are for information purposes only and the individual dose needs to be established by taking into account the current package insert for the elemental iron product used. Minor/Significance Unknown. Many patients with kidney disease cannot get enough iron from food and require injections. Deferasirox chelates iron. Iron Product. Adverse pregnancy outcomes associated with IDA include increased risk for preterm delivery and low birth weight. 1. Mean Corpuscular Hemoglobin Concentration (MCHC) Calculator, Red Blood Cell (RBC) Indices Calculator, Iron Deficiency In Pregnancy Calculator. Use Caution/Monitor. Modify Therapy/Monitor Closely. Where C= concentration of elemental iron (mg/ml) in the product being used: Data from Ferrlecit postmarketing spontaneous reports indicate that individual doses exceeding 125 mg may be associated with a higher incidence and/or severity of adverse events, Adult Patients with Hemodialysis Dependent-Chronic Kidney Disease (HDD-CKD), Adult Patients with Non-Dialysis Dependent-Chronic Kidney Disease (NDD-CKD), WARNING: RISK FOR SERIOUS HYPERSENSITIVITY/ANAPHYLAXIS REACTIONS, Iron Deficiency and Anemia- signs and therapeutic options. Applies only to oral form of both agents. Avoid or Use Alternate Drug. DOSAGE AND ADMINISTRATION: Venofer must only be administered intravenously either by slow injection or by infusion. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by at least 4 hours. Injectafer treatment may be repeated if iron deficiency anemia reoccurs. Minor/Significance Unknown. Use Caution/Monitor. Parenteral iron dose - UpToDate A patients lean body weight (or actual body weight if less than lean body weight) should be utilized when determining dosage. We'll do this entirely for free, as long as the calculator has applications for women's health. View the formulary and any restrictions for each plan. Monitor Closely (1)iron sucrose decreases levels of levothyroxine by inhibition of GI absorption. Use Caution/Monitor. Applies only to oral form of both agents. Dosage Calculator Use Caution/Monitor. Calcs that help predict probability of a disease, Subcategory of 'Diagnosis' designed to be very sensitive, Disease is diagnosed: prognosticate to guide treatment. VENOFER at IV doses up to 15 mg iron/kg/dose [about 10 times the maximum recommended human dose for a 70 kg person] given three times a week was found to have no effect on fertility . Maintain a well-balanced diet, and follow any dietary guidelines as directed by your doctor. iron sucrose decreases levels of doxycycline by inhibition of GI absorption. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients. Situation Analysis Market Size MAT Sales Cr LC MAT Share % MAT Gr % Total Pharma Market 9388.69 100 13.5 Iron Sucrose 11.18 93.81 37.65 Brand Company Saline MAT . Venofer must only be administered intravenously either by slow injection or by infusion. Recommended Treatment Regimen Using IV Iron Sucrose for Initial Repletion in Children With Iron Deficiency Anemia. Venofer and the Venofer logo are registered trademarks of Vifor (International) Inc., Switzerland. IDA symptoms are often nonspecific and include tiredness, weakness, shortness of breath. iron sucrose decreases levels of ibandronate by inhibition of GI absorption. 2010;18(3). VENOFER (IRON SUCROSE INJECTION,USP) 100mg ELEMENTAL IRON - DailyMed . For males: LBW = 50 kg + 2.3 kg for each inch of patients height over 5 feet For females: LBW = 45.5 kg + 2.3 kg for each inch of patients height over 5 feet. Parenteral iron dextran therapy: a review. UpToDate. Avoid or Use Alternate Drug. didanosine will decrease the level or effect of iron sucrose by increasing gastric pH. Use Caution/Monitor. PDF Venofer Guidelines for Use 2011 - University Health System Dose. Drug: Comments: A: Acyclovir 1: Dose using a 40% adjusted body weight; Amikacin 2: Dose using a 40% adjusted body weight; Amphotericin B (liposomal) 3 Consider capping body weight to 100 kg; Atracurium 4: Dose using ideal body weight; The use of ideal body weight has been shown to be associated with a more predictable muscle strength recovery within 60 minutes and a lack of need for antagonism . Drug Des Devel Ther; 5: 5160. This drug is available at a higher level co-pay. A patients lean body weight (or actual body weight if less than lean body weight) should be utilized when determining dosage. 3) Auerbach M, Witt D, Toler W, Fierstein M, Lerner RG, Ballard H. (1988) Clinical use of the total dose intravenous infusion of iron dextran. Do not administer Venofer to patients with evidence of iron overload. The original formula employs the weight in kg but users can input it in lbs and it gets transformed. This website is intended for use by US healthcare professionals only. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. * Adapted from the KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Hypotension following administration of Venofer may be related to rate of administration and/or total dose delivered. Avoid or Use Alternate Drug. Intravenous therapy is usually recommended in case of contraindications to oral iron, comorbidities that prevent absorption, chronic renal impairment or iron replacement needs to be rapid. Immune system disorders: Anaphylactic-type reactions, angioedema, Nervous system disorders: Convulsions, collapse, light-headedness, loss-of-consciousness, Respiratory, thoracic and mediastinal disorders: Bronchospasm, dyspnea, Musculoskeletal and connective tissue disorders: Back pain, swelling of the joints, General disorders and administration site conditions: Hyperhidrosis, Published studies on intravenous iron sucrose treatment after first trimester of pregnancy not shown adverse maternal or fetal outcomes; available reports of intravenous iron sucrose use in pregnant women during first trimester are insufficient to assess risk of major birth defects and miscarriage; iron deficiency anemia during pregnancy should be treated because there are risks to mother and fetus associated with untreated iron deficiency anemia (IDA) in pregnancy; risks to fetus associated with maternal severe hypersensitivity reactions, Severe adverse reactions including circulatory failure (severe hypotension, shock including in the context of anaphylactic reaction) may occur in pregnant women with parenteral iron products which may cause fetal bradycardia, especially during second and third trimester, Iron sucrose is present in human milk, and available published reports following exposure to 100-300 mg intravenous iron sucrose have not reported adverse reactions in breastfed infants; there are no data on effects on milk production, Developmental and health benefits of breastfeeding should be considered, along with mothers clinical need for treatment and any potential adverse effects on breastfed child from therapy or from underlying maternal condition. 5. Use Caution/Monitor. 1) Ganzoni AM. Applies only to oral form of both agents. It is usually given slowly over 2 to 5 minutes or as directed by your doctor. The incidence of adverse events with the 400- and 500-mg doses administered as a 2-hour . 2.1 . FERAHEME Dosing & Administration - Feraheme FERAHEME has flexible dosing for your patients FERAHEME flexible scheduling gives your patients the freedom to receive the iron they need as early as 3 days apart 1 FLEXIBLE DILUTION OPTIONS 1 Dilute full contents of vial (17 mL) in 50 mL to 200 mL of: 0.9% NaCl, or 5% dextrose STORAGE 1 If either is present, do not use the liquid. Iron sucrose can also be mixed in a saline solution and given through an IV over a longer time.Your dosage and length of treatment are based on your medical condition, age, and response to treatment. Iron Deficiency in Heart Failure - Home - American College of Cardiology calcium gluconate decreases levels of iron sucrose by inhibition of GI absorption. If hypersensitivity reactions or signs of intolerance occur during administration, stop Venofer immediately. Here are the steps to follow for using this drug dosage calculator: First, enter the value of your Weight and choose the unit of measurement from the drop-down menu. Administer Venofer 100 mg undiluted as a slow intravenous injection over 2 to 5 minutes, or as an infusion of 100 mg diluted in a maximum of 100 mL of 0.9% NaCl over a period of at least 15 minutes, per consecutive hemodialysis session [see How Supplied/Storage and Handling (16.2).] The normal ranges are: for males 13.8 to 18.0 g/dL (138 to 180 g/L, or 8.56 to 11.17mmol/L) and for females 12.1 to 15.1 g/dL (121 to 151 g/L, or 7.51 to 9.37mmol/L). Use Caution/Monitor. Administer iron products at least 2 hr before and no less than 6 hr after each dose to avoid chelation with magnesium. Corrected Sodium and Effective Osmolality.