Yes

Iron Salt

Prevention and treatment of iron deficiency anemias

A

Hemochromatosis, hemolytic anemia; known hypersensitivity to iron salts

Administration of iron for >6 months should be avoided except in patients with continued bleeding, menorrhagia, or repeated pregnancies; avoid in patients with peptic ulcer, enteritis, or ulcerative colitis. 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

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.

Absorption of oral preparation of iron and tetracyclines is 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. Concurrent administration greater than or equal to 200 mg vitamin C/30 mg elemental iron increases absorption of oral iron; milk may decrease absorption of 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 cells form and color changes within 3-10 days, peak reticulocytosis occurs in 5-10 days, and hemoglobin values increase within 2-4 weeks

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 mg twice daily up to 60 mg 4 times/day

Prophylaxis: 60 mg/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

Administration of iron preparations to premature infants with vitamin E deficiency may cause increased red cell hemolysis and hemolytic anemia, therefore, vitamin E deficiency should be corrected if possible

Therapeutic: Male: 75-175 mg/dL (SI: 13.4-31.3 mmol/L); Female: 65-165 mg/dL (SI: 11.6-29.5 mmol/L); serum iron level >300 mg/dL usually requires treatment of overdose due to severe toxicity

False-positive for blood in stool by the guaiac test

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 before or 4 hours after antacids

Monitor serum iron, total iron binding capacity, reticulocyte count, hemoglobin

Amount of elemental iron is listed in brackets

Elixir (Fergon®): 300 mg/5 mL [34 mg/5 mL] with alcohol 7% (480 mL)

Tablet: 300 mg [34 mg]; 325 mg [38 mg]

Fergon®, Ferralet®: 320 mg [37 mg]

Sustained release (Ferralet® Slow Release): 320 mg [37 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.