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: GI irritation, epigastric pain, nausea, dark stool, vomiting, stomach cramping, constipation

1% to 10%:

Gastrointestinal: Heartburn, diarrhea

Genitourinary: Discoloration of urine

Miscellaneous: Liquid preparations may temporarily stain the teeth

<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.

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: Concurrent administration greater than or equal to 200 mg vitamin C per 30 mg elemental Fe increases absorption of oral iron

Replaces iron, found in hemoglobin, myoglobin, and other 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: Occurs in 5-10 days, and hemoglobin values increase within 2-4 weeks

Absorption: Iron is absorbed in the duodenum and upper jejunum; in persons with normal serum 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 the intestinal mucosa, and by menstrual bleeding

Oral:

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 up to a maximum of 15 mg/day

Adults (dose expressed in terms of ferrous sulfate):

Iron deficiency: 300 mg twice daily up to 300 mg 4 times/day or 250 mg (extended release) 1-2 times/day

Prophylaxis: 300 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

Administer ferrous sulfate 2 hours prior to, or 4 hours after antacids

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%

False-positive for blood in stool by the guaiac test

None reported

None reported

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

Exsiccated, timed release (Feosol®): 159 mg [50 mg]

Exsiccated, timed release (Ferralyn® Lanacaps®, Ferra-TD®): 250 mg [50 mg]

Ferospace®: 250 mg [50 mg]

Drops, oral:

Fer-In-Sol®: 75 mg/0.6 mL [15 mg/0.6 mL] (50 mL)

Fer-Iron®: 125 mg/mL [25 mg/mL] (50 mL)

Elixir (Feosol®): 220 mg/5 mL [44 mg/5 mL] with alcohol 5% (473 mL, 4000 mL)

Syrup (Fer-In-Sol®): 90 mg/5 mL [18 mg/5 mL] with alcohol 5% (480 mL)

Tablet: 324 mg [65 mg]

Exsiccated (Feosol®) 200 mg [65 mg]

Exsiccated, timed release (Slow FE®): 160 mg [50 mg]

Feratab®: 300 mg [60 mg]

Mol-Iron®: 195 mg [39 mg]

Timed release (Fero-Gradumet®): 525 mg [105 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.