Iron Products
Synonyms :
Carbonyl Iron, Ferric Carboxymaltose, Ferric Citrate, Ferric Hydroxide Polymaltose Complex, Ferrous Ammonium Citrate, Ferrous Ascorbate, Ferrous Dextran, Ferrous Fumarate, Ferrous Gluconate, Ferrous Sulphate, Iron Dextran Complex
Mechanism :
The iron in circulation is immediately bound to the available protein moieties to form hemosiderin or ferritin, the physiological forms of iron, or to a lesser extent to transferrin. This iron which is subject to physiological control replenishes hemoglobin and depleted iron stores.
Indication :
- Iron deficiency anemia
- Prophylaxis of iron deficiency in low birth weight and breast-fed babies
Contraindications :
Contraindicated in known hypersensitivity, hemochromatosis, hemosiderosis, anemia not caused by iron deficiency. Parenteral iron is contraindicated in untreated pyelonephritis and in acute liver disease.
Dosing :
All mg doses are expressed as elemental iron.
Prophylaxis of iron deficiency in low birth weight and breast-fed babies:
<1 month: 5-6 mg PO once daily.
Infants and children <12 years: 1-2 mg/kg/day (Maximum 15 mg) in 1 to 2 divided doses.
Iron deficiency anemia:
Oral: Premature neonates: 2-4 mg/kg/day PO in divided doses, Max daily dose: 15 mg.
3 months-12 years: Mild to moderate iron deficiency anemia: 3 mg/kg PO in 2 divided doses. Severe iron deficiency anemia: 4-6 mg/kg PO in 2-3 divided doses
12-18 years: 180 mg PO in 3 divided doses.
IV/IM injection: Various formulations available are:
Iron
dextran: 50 mg/mL. Iron sucrose: 20 mg/mL, Ferric gluconate: 12.5 mg/mL. IV injection should not to be given in first 4 months of life. Sodium chloride 0.9% should be used as the diluent in total dose infusion. The various formulas can be used to determine the dose:
Iron dose (Mg) = (target Hb - actual Hb in g/L) x bodyweight(kg) x 0.24 + Iron depot
Note: 500 mg iron for iron stores is recommended if the body weight is above 35 kg.
Volume of product required (ML) = [weight (kg) x (14 - Hgb) x (2.145)]/C
Where C = concentration of elemental iron (Mg/ml) in the product being used:
Formula for Iron
dextran: Dose (ML) = 0.0442 (Desired Hb - Observed Hb) x LBW + (0.26 x LBW)
Adverse Effect :
Nausea, epigastric pain, diarrhea, constipation, black stools, taste disturbances, dizziness, flushing, stained teeth, headache. With IV iron: pain or discoloration at injection site, hypersensitivity side effects (dyspnea, urticaria, rashes, itching, arthralgia, myalgia, fever, and sweating, anaphylaxis), arthralgia, backache, myalgia, fever, chills, dizziness, headache, nausea and/or vomiting, chest pain or tightness, shock, hypotension, hypertension, tachycardia, flushing, and arrhythmias, leucocytosis, lymphadenopathy, latent folic acid deficiency, pleocytosis, pancytopenia, thrombocytopenia, and purpura.
Interaction :
Antacids, Milk, Tetracycline, Zinc: Absorption of oral iron is decreased.
Ciprofloxacin, Levofloxacin, Norfloxacin, Ofloxacin, Tetracycline, Levodopa, Penicillamine: Absorption is decreased by oral iron.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in normal renal function |
| HD | Not dialysed. Dose as in normal renal function |
| HDF/High flux | Not dialysed. Dose as in normal renal function |
| CAV/VVHD | Not dialysed. Dose as in normal renal function |
Hepatic Dose :
No dosage adjustments are recommended.