Drug reference
Blood and nutrition Iron-deficiency anaemia (therapeutic) ▶BY MOUTH USING ORAL SOLUTION ▶Child 1–11 months: Up to 2.5 mL twice daily, smaller doses to be used initially ▶Child 1–4 years: 2.5 mL 3 times a day ▶Child 5–11 years: 5 mL 3 times a day ▶Child 12–17 years: 5 mL 3 times a day, increased to 10 mL 3 times a day, dose to be increased gradually ▶Adult: 5 mL 3 times a day, increased to 10 mL 3 times a day, dose to be increased gradually
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Sytron ® contains 207.5 mg sodium feredetate trihydrate, which is equivalent to 27.5 mg of iron/5 mL.
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→Appendix 1: iron (oral)
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There can be variation in the licensing of different medicines containing the same drug. Oral solution ▶Sodium feredetate (Non-proprietary) Iron (as Sodium feredetate) 5.5 mg per 1 ml SodiFer 190mg/5ml oral solution sugar-free | 500 ml £12.07 DT = £14.95 ▶Sytron (Forum Health Products Ltd) Iron (as Sodium feredetate) 5.5 mg per 1 ml Sytron oral solution sugar-free | 500 ml p £14.95 DT = £14.95 1.3 Megaloblastic anaemia Anaemia, megaloblastic Overview Most megaloblastic anaemias result from a lack of either vitamin B12 or folate, and it is essential to establish in every case which deficiency is present and the underlying cause. In emergencies, when delay might be dangerous, it is sometimes necessary to administer both substances after the bone marrow test while plasma assay results are awaited. Normally, however, appropriate treatment should not be instituted until the results of tests are available. One cause of megaloblastic anaemia in the UK is pernicious anaemia in which lack of gastric intrinsic factor resulting from an autoimmune gastritis causes malabsorption of vitamin B12. Vitamin B12 is also needed in the treatment of megaloblastosis caused by prolonged nitrous oxide anaesthesia, which inactivates the vitamin, and in the rare syndrome of congenital transcobalamin II deficiency. Vitamin B12 should be given prophylactically after total gastrectomy or total ileal resection (or after partial gastrectomy if a vitamin B12 absorption test shows vitamin B12 malabsorption). Apart from dietary deficiency, all other causes of vitamin B12 deficiency are attributable to malabsorption. There is little place for the use of low-dose vitamin B12 orally and none for vitamin B12 intrinsic factor complexes given by mouth. Vitamin B12 in larger oral doses [unlicensed] may be effective. Hydroxocobalamin p. 1085 has completely replaced cyanocobalamin p. 1085 as the form of vitamin B12 of choice for therapy; it is retained in the body longer than cyanocobalamin and thus for maintenance therapy can be given at intervals of up to 3 months. Treatment is generally initiated with frequent administration of intramuscular injections to replenish the depleted body stores. Thereafter, maintenance treatment, which is usually for life, can be instituted. There is no evidence that doses larger than those recommended provide any additional benefit in vitamin B12 neuropathy. Folic acid below has few indications for long-term therapy since most causes of folate deficiency are self-limiting or will yield to a short course of treatment. It should not be used in undiagnosed megaloblastic anaemia unless vitamin B12 is administered concurrently otherwise neuropathy may be precipitated. In folate-deficient megaloblastic anaemia (e.g. because of poor nutrition, pregnancy, or antiepileptic drugs), daily folic acid supplementation for 4 months brings about haematological remission and replenishes body stores. For prophylaxis in chronic haemolytic states, malabsorption, or in renal dialysis, folic acid is given daily or sometimes weekly, depending on the diet and the rate of haemolysis. Folic acid is also used for the prevention of methotrexate- induced side-effects in severe Crohn’s disease, rheumatic disease, and severe psoriasis. Folinic acid p. 992 is also effective in the treatment of folate deficient megaloblastic anaemia but it is generally used in association with cytotoxic drugs; it is given as calcium folinate. There is no justification for prescribing multiple ingredient vitamin preparations containing vitamin B12 or folic acid. For the use of folic acid before and during pregnancy, see Neural tube defects (prevention in pregnancy) p. 1150. VITAMINS AND TRACE ELEMENTS › FOLATES
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Medicines for Children leaflet: Sytron (sodium feredetate) for the treatment of anaemia www.medicinesforchildren.org.uk/sytron- treatment-anaemia
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5 mL 3 times a day, increased to 10 mL 3 times a
First-line fragment. Read the complete Indications and Dose section above.
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