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IRON PREPARATIONS
Arun George
OG 4
need = 1200mg
Iron saved due to amenorrhoea = 300mg
Net need in pregnancy = 900mg
Mukherji J. Iron deficiency anemia in pregnancy. Rational Drug
Bull. 2002;12:25
the
Avg
amount
Therefore,
IRON SUPPLEMENTS
Oral preparations
API, 2008
Others
Iron polysaccharide
complex
(iron
polymaltose)
Carbonyl iron
Sodium
feredetate
Combination of iron
salts & Vit C,
succinate, fructose
Haemoglobin
preparations
Oral
Prophylaxis:
Iron supplementation
100mg elemental iron
500mcg folic acid
for 100 days
(national anemia control program)
Standard therapy
for
Although
Iron
General principles
Iron is not absorbed in the stomach and is absorbed
best from the duodenum and proximal jejunum, where
the iron transport proteins (eg, duodenal iron
transporter, divalent metal transport protein and the
iron export protein to blood, ferroportin) are most
strongly expressed.
Iron salts should not be given with food because
phosphates, phytates, and tannates in food bind the
iron and impair its absorption.
A number of other factors can inhibit the absorption of
iron salts, including antacids, H receptor blockers,
proton pump inhibitors, calcium-containing foods and
beverages, calcium supplements, certain antibiotics
(eg, quinolones, tetracycline), and the ingestion of iron
along with cereals, dietary fiber, tea, coffee, eggs, or
Iron
The
The
Gastrointestinal
Thus,
Patients
Response
Hemoglobin
increases at a rate of
0.1g/dL/day starting from the
second week of treatment.
Reticulocytosis
feeling of well being, appetite
No significant improvement in 3
weeks further evaluation
In
patients with inflammatory bowel disease, the use of oral iron has been
associated with worsening of the underlying disease, and may be poorly
tolerated and ineffective
inability
Gastrointestinal
Inflammation-mediated
Non-response
to oral iron therapy does not rule out iron deficiency in such
subjects, since two-thirds of the non-responders to oral iron in one study
responded to treatment with intravenous iron (ferric carboxymaltose).
CARBONYL Iron
Iron ascorbate
ADVANTAGES
a) Outstanding GI Tolerance
b) Very safe with no poisoning even
in high doses
c) No interaction with food stuffs
d) Delicious with non-metallic taste
and dont stain the patients
teeth
e) Compliance is very high
PARENTERAL
IRON
or unresponsive to oral
Iron
Necessity for faster increase in
haemoglobin (Elective surgery)
Malabsorption syndromes
Avoidance of allogenic blood
transfusion
Moderate to severe anemia around
30 weeks in pregnancy(ICMR)
Parental
Iron
High molecular weight, iron dextrose is NOT
recommended for use.
Newer preparations like iron sucrose are effective
and safe with minimal adverse reactions.
In comparison with patients who take iron
dextran, patients who take ferrous sucrose have
fewer allergic reactions (8.7 vs. 3.3 allergic
events per 1,000,000 doses) and a significantly
lower fatality rate (31 vs. 0,P<0.001), hence it
is the preferred molecule of choice.
Iron sucrose molecule used should have 30,000
60,000molwt.
Parenteral iron
Elemental
Fe Requirement (mg)
=
(N Hb Pt. Hb) X Wt(kg) x 2.21
+ 1000
administered as either a
bolus (undiluted) over 510min on
outpatient basis or short infusion less
than 30min (in 200ml Nacl (9g/l)).
Maximum
Parenteral preparations:
Intravenous preparation
a) Iron dextran (Imferon)
b) Iron sucrose
c) Sodium ferric gluconate (ferrlecit)
Intramuscular preparation
d) Iron Sorbitol Citrate in dextrin (Jectofer)
e) Iron Dextran (imferon)
IM ROUTE
Iron Dextran (1ml contains 50mg elemental
iron & 1amp=2ml)
Dose : 100 mg IM OD till the total dose over
Drawbacks:
a) Painful injection (less with jactofer).
b) Skin discoloration
c) Local abscess
d) Allergic reaction
e) Fe over load.
f) Category C drug
g) Gluteal sarcoma
h) Test dose needed
Advantage
Can be given in primary care set up
Absolute reticulocyte count increases in 7 days
Hemoglobin increases within 1-2 wks
Whole dose can be given in single setting
I/V Route :
a) Repeated Injections
b)Total dose infusion
Side effects:
- Anaphylactic reaction.
- Chest pain, rigors, chills, fall in
BP, dyspnoea, hemolysis.
Treatment:
a) Stop infusion.
b) Give antihistaminics,
corticosteroids & epinephrine.
IRON DEXTRAN
a) Colloidal solution of ferric
oxyhydroxide complexed with
polymersised dextran
b) Advantage : patients total iron
requirement is given in one
administration
c) Higher rate of adverse effects
like delayed hypotension/
arthralgia/abdominal pain
d) Test dose is necessary
e) Patients should be monitored 1
hr following a test dose of 25 mg
Given as IV injection/infusion
2)
3)
4)
IRON SUCROSE
Commonly
diseases
MW 34,000-60,000 D
Iron hydroxide sucrose complex in
water
Given as IV injection/infusion
Each ml contains 20 mg of Fe
After IV administration it
dissociates into iron & sucrose
T 1/2 is 6hrs
Category B drug
Total
Administered
100 mg IV over 5
thrice
weekly until
minutes,
1000 mg
200mg max dose per Sitting
Rate of administration should not
more than 20 mg/min
Infusion : 50 mg to be injected
slowly over 2 minutes, wait for 23 min ,then give another 50 mg
Iron
(FERRINJECT) :
a) Ferric
hydroxide
carbohydrate complex which
allows for control delivery of
iron within cells of the RES
(primarily bone marrow) and
subsequently delivery to the
iron binding proteins ferritin
and transferin
b)T1/2 : 16 hr
FERUMOXYTOL
ORAL Vs IV
Intravenous
Management of anaemia
on the basis of
haemoglobin levels
among pregnant and
lactating women
UNICEF INDIA National Iron Plus initiative Guidelines for
Control of IDA
Injectable
IM
If
If
Depending
Thank you
Romans 8:28
And we know that for those who love God all things work together
for good, for those who are called according to his purpose.