Usage
- Ferrous Ascorbate + Folic Acid is prescribed for the prevention and treatment of iron deficiency anemia and folate deficiency anemia, especially during pregnancy to prevent neural tube defects in the developing fetus. It’s also used to treat anemia caused by poor diet, malabsorption, or increased folate requirements (e.g., pregnancy). It is important to remember that folic acid supplementation can mask vitamin B12 deficiency.
- Pharmacological classification: Hematinic, Antianemic agent, Prenatal vitamin.
- Mechanism of Action: This combination replenishes iron and folate stores. Iron is essential for hemoglobin synthesis, increasing red blood cell production and oxygen-carrying capacity. Folic acid, a B vitamin, is crucial for DNA synthesis, cell division, and red blood cell formation, playing a vital role in fetal development.
Alternate Names
- Iron(II) ascorbate + Folic acid
- No widely recognized international variations exist.
- Brand Names: Orofer XT, Feronia, Ferium, Livogen, Irozorb, Ofofex XT, Imax XT, Glowin XT (Note: Brand names can vary by region).
How It Works
- Pharmacodynamics: Iron, as part of hemoglobin, binds oxygen in the lungs and transports it to tissues. Folic acid, converted to tetrahydrofolic acid, acts as a coenzyme in various metabolic processes, including purine and pyrimidine synthesis essential for DNA and RNA formation.
- Pharmacokinetics:
- Absorption: Iron is absorbed primarily in the duodenum and upper jejunum. Ascorbic acid enhances iron absorption. Folic acid is absorbed in the jejunum.
- Metabolism: Iron is stored as ferritin and hemosiderin. Folic acid is metabolized in the liver to tetrahydrofolic acid.
- Elimination: Iron is excreted primarily through exfoliation of intestinal mucosal cells and minor losses in bile, sweat, and urine. Folic acid is excreted mainly in the urine.
- Mode of Action: Iron is incorporated into heme, the oxygen-binding component of hemoglobin. Folic acid, as tetrahydrofolate, participates in one-carbon transfer reactions, essential for nucleotide biosynthesis.
- Receptor binding, enzyme inhibition, or neurotransmitter modulation: Not applicable in the classical sense for these nutrients.
Dosage
Standard Dosage
Adults:
- One tablet daily or as directed by the physician, containing 100mg of elemental iron and 1.5mg of folic acid. In severe cases, two tablets daily may be prescribed. Administer orally, preferably before meals with water, but it can be given with food to minimize gastrointestinal discomfort.
- Maximum daily dose: As per individual patient needs and tolerance.
Children:
- Syrup formulations are preferred. Dosage is calculated based on the child’s weight and the required elemental iron dose (6-10 mg/kg/day). Administer in 1-2 divided doses.
- Pediatric Safety Considerations: Iron overdose is a serious risk in children; keep out of reach. Monitor for signs of toxicity.
Special Cases:
- Elderly Patients: Start with lower doses and titrate as needed. Monitor closely for gastrointestinal side effects.
- Patients with Renal Impairment: Caution is advised. Dose adjustment may be required. Monitor serum creatinine and iron levels.
- Patients with Hepatic Dysfunction: Caution is advised. Dose adjustment may be required. Monitor liver function tests.
- Patients with Comorbid Conditions: Dosage adjustments may be necessary depending on the specific condition. For example, in patients with inflammatory bowel disease, monitor for gastrointestinal intolerance.
Clinical Use Cases
The provided sources focus primarily on the use of Ferrous Ascorbate + Folic Acid for iron and folate deficiency anemia and during pregnancy. Dosing in these contexts aligns with the standard adult and pediatric dosages.
Dosage Adjustments
Modify dosage based on patient response, hemoglobin levels, and iron studies. Adjustments might be needed for renal/hepatic impairment or other conditions impacting drug metabolism.
Side Effects
Common Side Effects
- Nausea, vomiting, stomach upset, constipation, diarrhea, dark-colored stools, metallic taste, abdominal discomfort, bloating, flatulence.
Rare but Serious Side Effects
- Allergic reactions (rash, itching, swelling), severe abdominal cramps, irritability, insomnia (with high doses).
Long-Term Effects
- No specific long-term side effects associated with appropriate use are reported in the sources, except for potential iron overload with chronic excessive intake.
Adverse Drug Reactions (ADR)
- Severe allergic reactions, iron toxicity (especially in children).
Contraindications
- Hypersensitivity to iron or folic acid.
- Hemochromatosis, hemosiderosis, hemolytic anemia.
- Bacterial infections (iron may worsen these).
- Pernicious anemia (vitamin B12 deficiency should be addressed first).
Drug Interactions
- Antacids, tetracyclines, cholestyramine, colestipol decrease iron absorption.
- Anticonvulsants (phenytoin, phenobarbital, primidone, sodium valproate, carbamazepine), chloramphenicol, cotrimoxazole, trimethoprim, lithium, triamterene, sulfasalazine, aspirin, methotrexate may interact.
- Dairy products, coffee, tea can reduce iron absorption if taken concurrently.
- Alcohol may decrease iron absorption.
Pregnancy and Breastfeeding
- Generally considered safe during pregnancy when prescribed by a doctor. Essential for preventing neural tube defects. Consult a doctor for appropriate dosage.
- Iron is excreted in breast milk. Consult a doctor before use while breastfeeding.
Drug Profile Summary
- Mechanism of Action: Replenishes iron and folate, essential for red blood cell production and fetal development.
- Side Effects: Nausea, constipation, dark stools, rarely allergic reactions or iron toxicity.
- Contraindications: Iron overload states, hemolytic anemia, certain anemias, hypersensitivity.
- Drug Interactions: Antacids, antibiotics, anticonvulsants, certain foods and beverages.
- Pregnancy & Breastfeeding: Generally safe during pregnancy, consult a doctor while breastfeeding.
- Dosage: Adults: 1-2 tablets daily; Children: based on weight and iron needs.
- Monitoring Parameters: Hemoglobin, hematocrit, iron studies.
Popular Combinations
- Ferrous Ascorbate + Folic Acid + Zinc Sulfate: Provides additional nutritional support and may further enhance red blood cell production and immune function.
Precautions
- General Precautions: Assess for allergies, pre-existing medical conditions, drug interactions. Monitor for side effects.
- Specific Populations: As detailed in the Dosage section.
- Lifestyle Considerations: Avoid concurrent intake of interacting substances. Counseling on appropriate diet.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ferrous Ascorbate + Folic Acid?
A: Adults: Typically, one tablet containing 100mg elemental iron and 1.5mg folic acid daily. Children: Dosage is based on weight and iron needs (6-10mg/kg/day). Consult guidelines for special populations.
Q2: Can Ferrous Ascorbate + Folic Acid be taken during pregnancy?
A: Yes, it is generally considered safe and often recommended during pregnancy, specifically to prevent neural tube defects. Consult a doctor for appropriate dosage.
Q3: What are the common side effects?
A: Common side effects include nausea, constipation, dark-colored stools, and stomach upset.
Q4: How should this medication be taken?
A: Take tablets orally with water, preferably before meals, or with food if gastrointestinal upset occurs. Syrup formulations should be shaken well before administration.
Q5: Who should not take Ferrous Ascorbate + Folic Acid?
A: Individuals with iron overload conditions (hemochromatosis, hemosiderosis), hemolytic anemia, or hypersensitivity to either component should not take this medication.
Q6: Does Ferrous Ascorbate + Folic Acid interact with other medications?
A: Yes, it can interact with antacids, tetracycline antibiotics, certain cholesterol medications, and others. Consult a doctor about all concomitant medications.
Q7: Can I take Ferrous Ascorbate + Folic Acid with food?
A: While preferably taken on an empty stomach, it can be taken with food to reduce gastrointestinal discomfort. Avoid consuming dairy products, coffee, or tea at the same time.
Q8: Can this combination be given to children?
A: Yes, but syrup formulations are preferred for children. Dosage is weight-based. Iron overdose is a risk in children; keep out of reach.
Q9: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose to catch up.
Q10: How long does it take to see improvement in anemia with this medication?
A: Hemoglobin levels typically start to rise within a few weeks, but it may take several months to reach normal values and replenish iron stores fully.
