Names and pronunciation
Ferrex, IFEREX, Nu-Iron, Poly Iron
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Drug reference
Ferrex, IFEREX, Nu-Iron, Poly Iron
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Func. class.: Hematinic
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Chem. class.: Iron preparation
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ACTION: Replaces iron stores needed for red blood cell development as well as energy and O2 transport and use; fuma- rate contains 33% elemental iron; gluco- nate, 12%; sulfate, 20%; iron, 30%; ferrous sulfate exsiccated
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USES: Iron-deficiency anemia, pro- phylaxis for iron deficiency in pregnancy, nutritional supplementation
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CONTRAINDICATIONS: thalas- semia, hemosiderosis/hemochromatosis Precautions: Pregnancy, anemia (long term), ulcerative colitis/regional enteritis, peptic ulcer disease, hemolytic anemia, cirrhosis, sulfite sensitivity
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Black Box Warning: Accidental exposure
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SIDE EFFECTS GI: Nausea, constipation, epigastric pain, black and red tarry stools, vomit- ing, diarrhea INTEG: Temporarily discolored tooth enamel and eyes
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INTERACTIONS Increase: action of iron preparation— ascorbic acid, chloramphenicol Decrease: absorption of penicillamine, levodopa, methyldopa, fluoroquinolones, l-thyroxine, tetracycline Decrease: absorption of iron prepara- tions—antacids, H2-antagonists, proton pump inhibitors, cholestyramine, vit E Drug/Food Decrease: absorption—dairy products, F caffeine, eggs Drug/Lab Test False positive: occult blood
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TREATMENT OF OVERDOSE: Induce vomiting; give eggs, milk until lavage can be done
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DOSAGE AND ROUTES Fumarate • Adult: PO 200-325 mg tid • Child: PO 3 mg/kg/day (elemental iron) tid-qid • Infant: PO 10-25 mg/day (elemental iron) in 3-4 divided doses, max 15 mg/day Gluconate • Adult: PO 50-100 mg elemental iron tid • Child: PO 3 mg/kg/day in divided doses Sulfate • Adult: PO 0.75-1.5 g/day in divided doses • Child 6-12 yr: PO 3 mg/kg/day in di- vided doses Pregnancy • Adult: PO 300-600 mg/day in divided doses Iron polysaccharide • Adult: PO 100-200 mg tid • Child: PO 4-6 mg/kg/day in 3 divided doses (severe iron deficiency)
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Available forms: Fumarate: tabs 90, 150, 200, 300, 324, 325 mg; chewable tabs 100 mg; ext rel tabs 18 mg; gluco- nate: tabs 225, 240, 324, 325 mg; sul- fate: tabs 195, 300, 325 mg; elixir 220 mg/5 mL; dried: tabs 200 mg; ext rel tabs 160 mg; ext rel caps 160 mg; iron polysaccharide: tabs 50 mg; caps 150 mg; sol 100 mg/5 mL
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Administer: PO route • Swallow tabs whole; do not break, crush, or chew unless labeled as chewable • Between meals for best absorption; may give with juice; do not give with ant- acids or milk, delay at least 1 hr; if GI symptoms occur, give after meals even if absorption is decreased; eggs, milk products, chocolate, caffeine interfere with absorption • Store in tight, light-resistant container • Liquid through plastic straw to avoid discoloration of tooth enamel; dilute thor- oughly • At least 1 hr before bedtime; corrosion may occur in stomach; ferrous gluconate is less irritating to GI tract than ferrous sulfate • For <6 mo for anemia
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Assess: • Blood studies: Hct, HB, reticulocytes, bilirubin before treatment, at least monthly; iron studies (iron, TIBC, fer- ritin); avoid use with blood transfu- sions, iron overload may occur • Toxicity: nausea, vomiting, diarrhea (green then tarry stools), hematemesis, pallor, cyanosis, shock, coma • Elimination: if constipation occurs, in- crease water, bulk, activity • Nutrition: amount of iron in diet (meat, dark green leafy vegetables, dried beans, dried fruits, eggs) • Cause of iron loss or anemia, including salicylates, sulfonamides, antimalarials, quiNIDine • Pregnancy/breastfeeding: no well-con- trolled studies; use only if benefits out- weigh fetal risk; excreted in breast milk
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Evaluate: • Therapeutic response: improvement in Hct, HB, reticulocytes; decreased fatigue, weakness
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That iron will turn stools black or dark green, stain teeth • Accidental exposure: to keep out of reach of children, pets; iron poisoning may occur if increased beyond recommended level • Not to substitute 1 iron salt for another; that elemental iron content differs (e.g., 300 mg ferrous fumarate contains about 100 mg elemental iron; 300 mg ferrous gluconate contains only about 30 mg elemental iron) • To avoid reclining position for 15-30 min after taking product to avoid esopha- geal corrosion • To follow a diet high in iron; to avoid taking iron, dairy products, calcium supplements, and vit C together because they compete for absorption
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PHARMACOKINETICS PO: Excreted in feces, urine, skin, breast milk; enters bloodstream; bound to transferrin; crosses placenta
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• Infant: PO 10-25 mg/day (elemental iron) in 3-4 divided doses, max 15 mg/day Gluconate
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