FERROUS SULFATE

FERROUS SULFATE (fer'rous sul'fate) Feosol, Fer-In-Sol, Fer-Iron, Fero-Gradumet, Ferospace, Ferralyn, Ferra-TD, Fesofor, Hematinic, Mol-Iron, Novoferrosulfa , Slow-Fe FERROUS FUMARATE (fer'rous foo'ma-rate) Feco-T, Femiron, Feostat, Fersamal, Fumasorb, Fumerin, Hemocyte, Ircon-FA, Neo-Fer-50 , Novofumar , Palafer , Palmiron FERROUS GLUCONATE (fer'rous gloo'koe-nate) Fergon, Fertinic , Novoferrogluc , Simron Classifications: blood former; iron preparation; Therapeutic: antianemic; iron supplement Pregnancy Category: A

Availability

Ferrous Sulfate: 167 mg, 200 mg, 324 mg, 325 mg tablets; 160 mg sustained release tablets, capsules; 90 mg/5 mL syrup; 220 mg/5 mL elixir; 75 mg/0.6 mL drops

Ferrous Fumarate: 63 mg, 100 mg, 200 mg, 324 mg, 325 mg, 350 mg tablets; 100 mg/5 mL suspension; 45 mg/0.6 mL drops

Ferrous Gluconate: 240 mg, 325 mg tablets

Action

Ferrous sulfate: Standard iron preparation that corrects erythropoietic abnormalities induced by iron deficiency but does not stimulate erythropoiesis. Ferrous gluconate: Claimed to cause less gastric irritation and be better tolerated than ferrous sulfate.

Therapeutic Effect

Effectiveness is experienced within 48 h as a sense of well-being, increased vigor, improved appetite, and decreased irritability (in children). Reticulocyte response begins in about 4 d; it usually peaks in 7–10 d and returns to normal after 2 or 3 wk. Hemoglobin generally increases by 2 g/dL and hematocrit by 6% in 3 wk.

Uses

To correct simple iron deficiency and to treat iron deficiency (microcytic, hypochromic) anemias. Also may be used prophylactically during periods of increased iron needs, as in infancy, childhood, and pregnancy.

Contraindications

Peptic ulcer, regional enteritis, ulcerative colitis; hemolytic anemias (in absence of iron deficiency), hemochromatosis, hemosiderosis, patients receiving repeated transfusions, pyridoxine-responsive anemia; cirrhosis of liver.

Cautious Use

Hepatic disease; GI diseases; sulfite hypersensitivity; pregnancy (category A).

Route & Dosage

Iron Deficiency Adult: PO Sulfate (30% elemental iron) 750–1500 mg/d in 1–3 divided doses; Fumarate (33% elemental iron) 200 mg t.i.d. or q.i.d.; Gluconate (12% elemental iron) 325–600 mg q.i.d., may be gradually increased to 650 mg q.i.d. as needed and tolerated Child: PO Sulfate (30% elemental iron) <6 y, 75–225 mg/d in divided doses; 6–12 y, 600 mg/d in divided doses; Fumarate (33% elemental iron) 3 mg/kg t.i.d.; Gluconate (12% elemental iron) <6 y, 100–300 mg/d in divided doses; 6–12 y, 100–300 mg t.i.d. Iron Supplement Adult: PO Sulfate Pregnancy, 300–600 mg/d in divided doses; Fumarate 200 mg once/d; Gluconate 325–600 mg once/d Child: PO Fumarate 3 mg/kg once/d; Gluconate <6 y, 100–300 mg/d in divided doses; 6–12 y, 100–300 mg once/d Infant: PO Fumarate Low birth weight, 2 mg/kg/d up to 15 mg/d; ???, 1 mg/kg/d (max: 15 mg/d)

Administration

Oral

• Give on an empty stomach if possible because oral iron preparations are best absorbed then (i.e., between meals). Minimize gastric distress if needed by giving with or immediately after meals with adequate liquid.
• Do not crush tablet or empty contents of capsule when administering.
• Do not give tablets or capsules within 1 h of bedtime.
• Consult physician about prescribing a liquid formulation or a less corrosive form, such as ferrous gluconate, if the patient experiences difficulty in swallowing tablet or capsule.
• Dilute liquid preparations well and give through a straw or placed on the back of tongue with a dropper to prevent staining of teeth and to mask taste. Instruct the patient to rinse mouth with clear water immediately after ingestion.
• Mix ferosol elixir with water; not compatible with milk or fruit juice. Fer-In-Sol (drops) may be given in water or in fruit or vegetable juice, according to manufacturer.
• Do not use discolored tablets.
• Store in tightly closed containers and protect from moisture. Store at 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

GI: Nausea, heartburn, anorexia, constipation, diarrhea, epigastric pain, abdominal distress, black stools. Special Senses: Yellow-brown discoloration of eyes and teeth (liquid forms). Large Chronic Doses in Infants Rickets (due to interference with phosphorus absorption). Massive Overdosage Lethargy, drowsiness, nausea, vomiting, abdominal pain, diarrhea, local corrosion of stomach and small intestines, pallor or cyanosis, metabolic acidosis, shock, cardiovascular collapse, convulsions, liver necrosis, coma, renal failure, death.

Diagnostic Test Interference

By coloring feces black, large iron doses may cause false-positive tests for occult blood with orthotoluidine (Hematest, Occultist, Labstix); guaiac reagent benzidine test is reportedly not affected.

Interactions

Drug: antacids decrease iron absorption; iron decreases absorption of tetracyclines, ciprofloxacin, ofloxacin; chloramphenicol may delay iron's effects; iron may decrease absorption of penicillamine. Food: Food decreases absorption of iron; ascorbic acid (vitamin C) may increase iron absorption.

Pharmacokinetics

Absorption: 5–10% absorbed in healthy individuals; 10–30% absorbed in iron-deficiency; food decreases amount absorbed. Distribution: Transported by transferrin to bone marrow, where it is incorporated into hemoglobin; crosses placenta. Elimination: Most of iron released from hemoglobin is reused in body; small amounts are lost in desquamation of skin, GI mucosa, nails, and hair; 12–30 mg/mo lost through menstruation.

Nursing Implications

Assessment & Drug Effects

• Lab tests: Monitor Hgb and reticulocyte values during therapy. Investigate the absence of satisfactory response after 3 wk of drug treatment.
• Continue iron therapy for 2–3 mo after the hemoglobin level has returned to normal (roughly twice the period required to normalize hemoglobin concentration).
• Monitor bowel movements as constipation is a common adverse effect.

Patient & Family Education

• Note: Ascorbic acid increases absorption of iron. Consuming citrus fruit or tomato juice with iron preparation (except the elixir) may increase its absorption.
• Be aware that milk, eggs, or caffeine beverages when taken with the iron preparation may inhibit absorption.
• Be aware that iron preparations cause dark green or black stools.
• Report constipation or diarrhea to physician; symptoms may be relieved by adjustments in dosage or diet or by change to another iron preparation.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug