Yes

Iron Salt

Prevention and treatment of iron deficiency anemias

A

Hemochromatosis, hemolytic anemia, known hypersensitivity to iron salts

Avoid in patients with peptic ulcer, enteritis, or ulcerative colitis. Administration of iron for >6 months should be avoided except in patients with continuous bleeding or menorrhagia. Anemia in the elderly is often caused by "anemia of chronic disease" or associated with inflammation rather than blood loss. Iron stores are usually normal or increased, with a serum ferritin >50 ng/mL and a decreased total iron binding capacity. Hence, the "anemia of chronic disease" is not secondary to iron deficiency but the inability of the reticuloendothelial system to reclaim available iron stores.

>10%: Gastrointestinal: Stomach cramping, constipation, nausea, vomiting, dark stools

1% to 10%:

Gastrointestinal: Heartburn, diarrhea, staining of teeth

Genitourinary: Discoloration of urine

<1%: Contact irritation

Symptoms of overdose include acute GI irritation, erosion of GI mucosa, hepatic and renal impairment, coma, hematemesis, lethargy, acidosis, serum Fe level >300 mcg/mL requires treatment of overdose due to severe toxicity

Following treatment for fluid losses, metabolic acidosis, and shock, a severe iron overdose may be treated with deferoxamine. Deferoxamine may be administered I.V. (80 mg/kg over 24 hours) or I.M. (40-90 mg/kg every 8 hours). Usual toxic dose of elemental iron: greater than or equal to 35 mg/kg.

Decreased effect: Absorption of oral preparation of iron and tetracyclines are decreased when both of these drugs are given together; concurrent administration of antacids may decrease iron absorption; iron may decrease absorption of penicillamine when given at the same time; response to iron therapy may be delayed in patients receiving chloramphenicol

Milk may decrease absorption of iron

Increased effect: Current administration greater than or equal to 200 mg vitamin C per 30 mg elemental iron increases absorption of oral iron

Replaces iron found in hemoglobin, myoglobin, and enzymes; allows the transportation of oxygen via hemoglobin

Onset of hematologic response (essentially the same to either oral or parenteral iron salts): Red blood cell form and color changes within 3-10 days

Peak reticulocytosis: Within 5-10 days; hemoglobin values increase within 2-4 weeks

Absorption: Iron is absorbed in the duodenum and upper jejunum; in persons with normal iron stores 10% of an oral dose is absorbed, this is increased to 20% to 30% in persons with inadequate iron stores; food and achlorhydria will decrease absorption

Elimination: Iron is largely bound to serum transferrin and excreted in the urine, sweat, sloughing of intestinal mucosa, and by menses

Oral (dose expressed in terms of elemental iron):

Severe iron deficiency anemia: 4-6 mg Fe/kg/day in 3 divided doses

Mild to moderate iron deficiency anemia: 3 mg Fe/kg/day in 1-2 divided doses

Prophylaxis: 1-2 mg Fe/kg/day

Adults:

Iron deficiency: 60-100 mg twice daily up to 60 mg 2 times/day

Prophylaxis: 60-100 mg/day

To avoid GI upset, start with a single daily dose and increase by 1 tablet/day each week or as tolerated until desired daily dose is achieved

Elderly: 200 mg 3-4 times/day

Should be administered with water or juice on an empty stomach; may be administered with food to prevent irritation; however, not with cereals, dietary fiber, tea, coffee, eggs, or milk

Serum iron:

Male: 75-175 mg/dL (SI: 13.4-31.3 mmol/L)

Female: 65-165 mg/dL (SI: 11.6-29.5 mmol/L)

Total iron binding capacity: 230-430 mg/dL

Transferrin: 204-360 mg/dL

Percent transferrin saturation: 20% to 50%

Iron levels >300 mg/dL can be considered toxic, should be treated as an overdose

No information available to require special precautions

Do not prescribe tetracyclines simultaneously with iron since GI tract absorption of both tetracycline and iron may be inhibited

May color stool black, take between meals for maximum absorption; may take with food if GI upset occurs, do not take with milk or antacids; keep out of reach of children

Administer 2 hours prior to or 4 hours after antacids

Amount of elemental iron is listed in brackets

Drops (Feostat®): 45 mg/0.6 mL [15 mg/0.6 mL] (60 mL)

Suspension, oral (Feostat®): 100 mg/5 mL [33 mg/5 mL] (240 mL)

Tablet:

325 mg [106 mg]

Chewable (chocolate flavor) (Feostat®): 100 mg [33 mg]

Femiron®: 63 mg [20 mg]

Fumerin®: 195 mg [64 mg]

Fumasorb®, Ircon®: 200 mg [66 mg]

Hemocyte®: 324 mg [106 mg]

Nephro-Fer™: 350 mg [115 mg]

Timed release (Ferro-Sequels®): Ferrous fumarate 150 mg [50 mg] and docusate sodium 100 mg

Lipschitz DA, "The Anemia of Chronic Disease," J Am Geriatr Soc, 1990, 38(11):1258-64.

Marx JJM, "Normal Iron Absorption and Decreased Red Cell Iron Uptake in the Aged," Blood, 1979, 53:204-11.