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: bloods formers, coagulators, and anticoagulants; iron preparation
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

Actions

Ferrous sulfate: Standard iron preparation against which other oral iron preparations are usually measured. Corrects erythropoietic abnormalities induced by iron deficiency but does not stimulate erythropoiesis. May reverse gastric, esophageal, and other tissue changes caused by lack of iron. Ferrous gluconate: Claimed to cause less gastric irritation and be better tolerated than ferrous sulfate.

Therapeutic Effects

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 (reticulocytosis) and returns to normal after 2 or 3 wk. Hemoglobin generally increases by 2 g/dL and hematocrit by 6% in 3 wk. Iron supplements correct erythropoietic abnormalities induced by iron deficiency but do not stimulate erythropoiesis.

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

Pregnancy (category A), lactation.

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; 3 y, 1 mg/kg/d (max: 15 mg/d)

Administration

Oral

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

Patient & Family Education


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