Iron supplement
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Trade names | Feosol, Feostat, Feratab, others |
Other names | Iron pills, iron salts, ferrous salts, ferric salts |
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intramuscular | |
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Iron supplements, also known as iron salts and iron pills, are a number of
Common side effects include
Iron pills have been used medically since at least 1681, with an easy-to-use formulation being created in 1832.
Medical uses
Iron supplements are used to treat or prevent
Iron deficiency anemia is classically a microcytic, hypochromic anemia. Generally, in the UK oral preparations are trialled before using parenteral delivery,
Athletes
Athletes may be at elevated risk of iron deficiency and so benefit from supplementation, but the circumstances vary between individuals and dosage should be based on tested ferritin levels, since in some cases supplementation may be harmful.[20]
Frequent blood donors
Frequent blood donors may be advised to take iron supplements.
Side effects
Side effects of therapy with oral iron are most often
The patient may notice that their stools become black. This is completely harmless, but patients must be warned about this to avoid unnecessary concern. When iron supplements are given in a liquid form, teeth may reversibly discolor (this can be avoided through the use of a straw). Intramuscular injection can be painful, and brown discoloration may be noticed.
Treatments with iron(II) sulfate have higher incidence of adverse events than iron(III)-hydroxide polymaltose complex (IPC)[24][25][26] or iron bis-glycinate chelate.[27][28]
Iron overdose has been one of the leading causes of death caused by toxicological agents in children younger than six years.[29]
Iron poisoning may result in mortality or short-term and long-term morbidity.[30]
Infection risk
Because one of the functions of elevated ferritin (an acute phase reaction protein) in acute infections is thought to be to sequester iron from bacteria, it is generally thought that iron supplementation (which circumvents this mechanism) should be avoided in patients who have active bacterial infections. Replacement of iron stores is seldom such an emergency situation that it cannot wait for any such acute infection to be treated.
Some studies have found that iron supplementation can lead to an increase in
Children living in areas prone for malarial infections are also at risk of developing anemia. It was thought that iron supplementation given to such children could increase the risk of malarial infection in them. A Cochrane systematic review published in 2016 found high quality evidence that iron supplementation does not increase the risk of clinical malaria in children.[32]
Contraindications
Contraindications often depend on the substance in question. Documented hypersensitivity to any ingredients and anemias without proper work-up (i.e., documentation of iron deficiency) is true of all preparations. Some can be used in iron deficiency, others require iron deficiency anaemia to be present. Some are also contraindicated in rheumatoid arthritis.[2]
Hemochromatosis
Individuals may be genetically predisposed to excessive iron absorption, as is the case with those with
Interactions
Non-
Many other substances decrease the rate of non-heme iron absorption. One example is
Taken after a meal, there are fewer side effects but there is also less absorption because of interaction and pH alteration. Generally, an interval of 2–3 hours between the iron intake and that of other drugs seems advisable, but is less convenient for patients and can impact on compliance.
History
The first pills were commonly known as Blaud's pills,
Administration
By mouth
Iron can be supplemented
Heme iron polypeptide (HIP) (e.g. Proferrin ES and Proferrin Forte) can be used when regular iron supplements such as ferrous sulfate or ferrous fumarate are not tolerated or absorbed. A clinical study demonstrated that HIP increased serum iron levels 23 times greater than ferrous fumarate on a milligram-per-milligram basis.[42]
Another alternative is ferrous
Since iron stores in the body are generally depleted, and there is a limit to what the body can process (about 2–6 mg/kg of body mass per day; i.e. for a 100 kg/220 lb man this is equal to a maximum dose of 200–600 mg/per day) without iron poisoning, this is a chronic therapy which may take 3–6 months.[45]
Due to the frequent intolerance of oral iron and the slow improvement, parenteral iron is recommended in many indications.[46][47]
By injection
Iron therapy (intravenously or intramuscular) is given when therapy by mouth has failed (not tolerated), oral absorption is seriously compromised (by illnesses, or when the person cannot swallow), benefit from oral therapy cannot be expected, or fast improvement is required (for example, prior to elective surgery).
There are cases where parenteral iron is preferable over oral iron. These are cases where oral iron is not tolerated, where the
Low-certainty evidence suggests that IBD-related anemia treatment with
In many cases, use of intravenous iron such as ferric carboxymaltose has lower risks of adverse events than a blood transfusion and as long as the person is stable is a better alternative.[50] Ultimately this always remains a clinical decision based on local guidelines, although National Guidelines are increasingly stipulating IV iron in certain groups of patients.[51][52]
A Cochrane review of controlled trials comparing intravenous (IV) iron therapy with oral iron supplements in people with chronic kidney disease, found low-certainty evidence that people receiving IV-iron treatment were 1.71 times as likely to reach their target hemoglobin levels.[53] Overall, hemoglobin was 0.71g/dl higher than those treated with oral iron supplements. Iron stores in the liver, estimated by serum ferritin, were also 224.84 µg/L higher in those receiving IV-iron.[53] However, there was also low-certainty evidence that allergic reactions were more likely following IV-iron therapy. It was unclear whether type of iron therapy administration affects the risk of death from any cause, including cardiovascular, nor whether it may alter the number of people who may require a blood transfusion or dialysis.[53]
Soluble iron salts have a significant risk of adverse effects and can cause toxicity due to damage to cellular macromolecules. Delivering iron parenterally has utilised various different molecules to limit this. This has included
One formulation of parenteral iron is iron dextran which covers the old high molecular weight (brand name Dexferrum) and the much safer low molecular iron dextrans (brand names including Cosmofer and Infed).[54]
Iron
Iron carboxymaltose is marketed as Ferinject,
Iron isomaltoside 1000 (brand name Monofer) is a formulation of parenteral iron that has a matrix structure that results in very low levels of free iron and labile iron. It can be given at high doses – 20 mg/kg in a single visit – no upper dose limit. This formulation has the benefit of giving a full iron correction in a single visit.[59][58]
Ferric maltol, marketed as Accrufer[5] and Ferracru, is available in oral and intravenous preparations. When used as a treatment for IBD-related anemia, very low certainty evidence suggests a marked benefit with oral ferric maltol compared with placebo. However it was unclear whether the IV preparation was more effective than oral ferric maltol.[49]
References
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- ^ a b "Cosmofer – Summary of Product Characteristics (SPC)". eMC. Archived from the original on 26 April 2014. Retrieved 21 December 2012.
- ^ a b c d e "Ferinject 50 mg iron/mL dispersion for injection/infusion". emc.
- ^ a b c "Injectafer- ferric carboxymaltose injection injection, solution; Injectafer- ferric carboxymaltose injection, solution". DailyMed. 1 May 2023. Retrieved 8 February 2024.
- ^ a b "Drug Approval Package: Accrufer". U.S. Food and Drug Administration (FDA). 14 August 2019. Retrieved 8 February 2024.
- ^ ISBN 9781284057560.
- ^ ISBN 9780857111562.
- ^ ISBN 9789241547659.
- ^ a b c "Iron Preparations, Oral". The American Society of Health-System Pharmacists. Archived from the original on 22 May 2016. Retrieved 8 January 2017.
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- hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
- ^ "The Top 300 of 2021". ClinCalc. Archived from the original on 15 January 2024. Retrieved 14 January 2024.
- ^ "Ferrous Sulfate - Drug Usage Statistics". ClinCalc. Retrieved 14 January 2024.
- ^ "Ferric carboxymaltose". Farbe Firma Pvt Ltd. 28 June 2023.
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- ^ "What you need to know about iron". Canadian Blood Services. Retrieved 30 May 2022.
- ^ "Frequent Blood Donors and the Importance of Iron". American Red Cross Blood Services. Retrieved 30 May 2022.
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Allergiska reaktioner (inträffar hos färre än 1 av 1 000 patienter)" and "Vanliga (inträffar hos färre än 1 av 10 patienter): Tillfälliga smakförändringar (speciellt metallsmak).
- ^ "Venofer (iron sucrose) - Summary of Product Characteristics (SmPC)". eMC. Archived from the original on 8 March 2017. Retrieved 7 March 2017.
- ^ "Drug Approval Package: Injectafer (ferric carboxymaltose) Injection NDA #203565". U.S. Food and Drug Administration (FDA). 4 September 2013. Retrieved 8 February 2024.
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