Usage
- Carbonyl iron is prescribed for the prevention and treatment of iron deficiency anemia. It is also used as a dietary iron supplement.
- Pharmacological classification: Hematinic, mineral supplement.
- Mechanism of Action: Carbonyl iron provides elemental iron, which is essential for hemoglobin synthesis. Hemoglobin is the protein in red blood cells responsible for carrying oxygen throughout the body. It also plays a crucial role in myoglobin formation (oxygen storage in muscle cells) and various cellular processes.
Alternate Names
- Elemental iron
- Brand names: Feosol Caplet, Icar, Iron Chews, Wee Care, Ferra-Cap
How It Works
- Pharmacodynamics: Carbonyl iron replenishes depleted iron stores in the body, primarily affecting red blood cell production and oxygen transport. Adequate iron levels are crucial for normal erythropoiesis and overall cellular function.
- Pharmacokinetics: Carbonyl iron is absorbed in the ferrous form after being converted by gastric acid. Its absorption is slower and more gradual than ferrous sulfate, resulting in higher bioavailability and less toxicity with overdose. It is absorbed predominantly in the duodenum and proximal jejunum.
- Mode of action: Carbonyl iron dissolves in gastric acid, releasing ferrous ions, which are then absorbed. These ions are incorporated into hemoglobin within red blood cells in the bone marrow.
- Elimination: Iron is primarily lost through blood loss (e.g., menstruation) and shedding of cells from the skin and gastrointestinal tract. Excess iron is stored in the liver, spleen, and bone marrow as ferritin or hemosiderin. Iron is not actively excreted from the body.
Dosage
Standard Dosage
Adults:
- Iron Deficiency Anemia: 300 mg (expressed as ferrous sulfate) orally every 12 hours; may increase to 300 mg every 6 hours or 250 mg extended-release (ER) orally every 12 hours. Equivalent doses of carbonyl iron should be calculated based on elemental iron content.
- Prophylaxis of Iron Deficiency: 300 mg (expressed as ferrous sulfate) orally once daily. Equivalent doses of carbonyl iron should be calculated based on elemental iron content.
Children:
- Premature neonates: 2 to 4 mg elemental iron/kg/day divided every 12 to 24 hours (maximum daily dose = 15 mg)
- Infants and Children <12 years:
- Prophylaxis: 1 to 2 mg elemental iron/kg/day (maximum 15 mg) in 1 to 2 divided doses.
- Mild to moderate iron deficiency anemia: 3 mg elemental iron/kg/day in 1 to 2 divided doses.
- Severe iron deficiency anemia: 4 to 6 mg elemental iron/kg/day in 3 divided doses.
- Dosage should be calculated based on the specific carbonyl iron product’s elemental iron content.
Special Cases:
- Elderly Patients: Standard adult dose, monitor for gastrointestinal side effects.
- Patients with Renal Impairment: No specific dose adjustment is generally necessary, as iron is not primarily excreted by the kidneys. Monitor closely.
- Patients with Hepatic Dysfunction: Use with caution, monitor iron levels and liver function.
- Patients with Comorbid Conditions: Consider underlying conditions and adjust as needed.
Clinical Use Cases
Dosage recommendations for specific medical settings related to intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations are not specifically indicated for carbonyl iron. Its primary role is in managing iron deficiency or preventing it.
Dosage Adjustments
Dose adjustments should be made based on individual patient response and monitoring of iron levels. Consider factors like renal/hepatic function and other medical conditions.
Side Effects
Common Side Effects:
- Nausea, vomiting, constipation, diarrhea, dark stools, abdominal pain, heartburn.
Rare but Serious Side Effects:
- Allergic reactions (hives, difficulty breathing, swelling), iron overload (hemosiderosis with prolonged high doses).
Long-Term Effects:
- Hemosiderosis (iron overload) can occur with prolonged use of high doses.
Adverse Drug Reactions (ADR):
- Severe allergic reactions, iron toxicity.
Contraindications
- Hypersensitivity to carbonyl iron, hemochromatosis, hemolytic anemia, anemia not caused by iron deficiency, peptic ulcer, regional enteritis, ulcerative colitis.
Drug Interactions
- Antacids, antibiotics (e.g., tetracyclines, quinolones), levodopa, penicillamine, thyroid medications (levothyroxine), bisphosphonates, stomach acid reducers (e.g., cimetidine, ranitidine). Avoid taking carbonyl iron within 2 hours of these medications.
Pregnancy and Breastfeeding
- Iron requirements increase during pregnancy. Carbonyl iron can be used to treat iron deficiency anemia during pregnancy under the guidance of a healthcare professional. However, it’s crucial not to exceed the recommended daily allowance. Supplementation may continue for several weeks postpartum to replenish maternal iron stores.
- Carbonyl iron is excreted in breast milk. Consult a doctor before breastfeeding while taking this medication.
Drug Profile Summary
- Mechanism of Action: Replenishes iron stores, essential for hemoglobin synthesis and oxygen transport.
- Side Effects: Nausea, vomiting, constipation, diarrhea, dark stools, abdominal pain. Rarely, allergic reactions and iron overload.
- Contraindications: Hypersensitivity, hemochromatosis, hemolytic anemia, other non-iron deficiency anemias, certain gastrointestinal conditions.
- Drug Interactions: Antacids, certain antibiotics, levodopa, penicillamine, thyroid medications.
- Pregnancy & Breastfeeding: Can be used in pregnancy if needed, consult doctor while breastfeeding.
- Dosage: Varies based on age, indication, and formulation. See detailed dosage section.
- Monitoring Parameters: Hemoglobin, hematocrit, iron levels, ferritin.
Popular Combinations
Often combined with folic acid, especially during pregnancy, to support red blood cell production.
Precautions
- General Precautions: Assess iron status before starting therapy.
- Specific Populations: Monitor pregnant and breastfeeding women, children, and elderly patients closely.
- Lifestyle Considerations: Taking carbonyl iron with food may reduce gastrointestinal side effects.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Carbonyl Iron?
A: The dosage varies depending on age, condition being treated, and the specific carbonyl iron product. Please refer to the detailed dosage section for specific recommendations.
Q2: What are the common side effects of Carbonyl Iron?
A: Common side effects include gastrointestinal issues like constipation, diarrhea, nausea, and dark stools.
Q3: Can Carbonyl Iron be taken during pregnancy?
A: Yes, under the guidance of a doctor, it can be used to treat iron deficiency anemia during pregnancy. Do not exceed the recommended dose.
Q4: How does Carbonyl Iron differ from other iron supplements?
A: Carbonyl iron is a form of elemental iron with slower absorption and higher bioavailability compared to ferrous sulfate, potentially leading to fewer gastrointestinal side effects and less toxicity risk.
Q5: What are the contraindications for Carbonyl Iron?
A: Contraindications include hemochromatosis, hemolytic anemia, and certain gastrointestinal conditions. It should not be used in individuals with anemias not caused by iron deficiency.
Q6: Does Carbonyl Iron interact with other medications?
A: Yes, it can interact with antacids, certain antibiotics (tetracyclines, quinolones), and other medications. Consult a doctor or pharmacist about potential interactions.
Q7: How is Carbonyl Iron absorbed?
A: It is dissolved by gastric acid and absorbed in the ferrous form in the duodenum and proximal jejunum.
Q8: Can I take Carbonyl Iron if I am breastfeeding?
A: Consult a doctor before using carbonyl iron while breastfeeding, as it’s excreted in breast milk.
Q9: What should I monitor while taking Carbonyl Iron?
A: Hemoglobin, hematocrit, iron levels, and ferritin should be monitored regularly. Be aware of signs of potential gastrointestinal side effects.
