Ferrous asparto glycinate + L-Methyl Folate + Methylcobalamin

Usage

This combination medication is prescribed for the treatment and prevention of nutritional deficiencies, predominantly iron-deficiency anemia, megaloblastic anemia (caused by vitamin B12 or folate deficiency), and during pregnancy to ensure adequate levels of iron, folate, and vitamin B12. It helps restore iron levels, supports red blood cell production, and promotes nerve health. It is also prescribed in general to improve overall health and wellbeing.

Pharmacological Classification: Hematinic, Vitamin Supplement, Antianemic

Alternate Names

• Iron Asparto Glycinate + L-Methylfolate + Methylcobalamin
• Ferrous(II) Asparto Glycinate + (6S)-5-Methyltetrahydrofolic acid + Methylcobalamin

Some brand names for this combination include Fag HB Softgel Capsule, Fagwell Tablet and Finered Tablet. It’s important to note that brand names can vary regionally.

How It Works

Pharmacodynamics:

• Ferrous Asparto Glycinate: Delivers iron, which is crucial for hemoglobin synthesis within red blood cells. Hemoglobin is the protein responsible for oxygen transport throughout the body. It is a readily absorbable form of iron, thus beneficial in treating iron deficiency.
• L-Methyl Folate: The biologically active form of folate, also known as Vitamin B9, essential for DNA synthesis, cell division, and red blood cell maturation. It plays a critical role in preventing neural tube defects during fetal development. It is preferred over folic acid in individuals with certain genetic polymorphisms related to folate metabolism.
• Methylcobalamin: The active coenzyme form of Vitamin B12, vital for nerve function, DNA synthesis, and red blood cell maturation. It aids in the synthesis of myelin, a protective sheath around nerve fibers, and participates in nerve cell repair. It also aids in the conversion of homocysteine to methionine.

Pharmacokinetics:

• Absorption: Ferrous asparto glycinate is absorbed in the small intestine. L-methylfolate is absorbed primarily in the jejunum, and methylcobalamin is absorbed via intrinsic factor-mediated transport in the ileum.
• Metabolism: Methylcobalamin is stored in the liver and is not extensively metabolized. L-methylfolate undergoes metabolic conversion to tetrahydrofolic acid, the active form of folate. Iron is incorporated into hemoglobin.
• Elimination: Iron is primarily lost through blood loss and shedding of epithelial cells. Excess folate is excreted in the urine, and excess Vitamin B12 is excreted in the bile and urine.

Dosage

Dosage guidelines for Ferrous asparto glycinate + L-Methyl Folate + Methylcobalamin can vary depending on the patient’s specific needs, severity of deficiency, and the formulation of the medicine. It is crucial to follow the dosage instructions given by the doctor and printed on the package. However, some general dosage information can be mentioned.

Standard Dosage

Adults:

The typical dosage for adults is one capsule or tablet daily or as directed by the physician. It’s crucial to monitor blood levels of iron, vitamin B12, and folate to adjust the dosage as needed. The dosage may vary based on the severity of the deficiency.

Children:

Dosage for children should be determined by a pediatrician based on the child’s age, weight, and clinical condition. The safety and efficacy of this combination in children have not been fully established for all age groups.

Special Cases:

• Elderly Patients: Dosage adjustments may be necessary due to age-related changes in kidney and liver function.
• Patients with Renal Impairment: Dose adjustments should be considered based on the degree of renal impairment.
• Patients with Hepatic Dysfunction: Caution should be exercised when prescribing this combination to patients with liver dysfunction. Dose adjustments may be necessary.
• Patients with Comorbid Conditions: Dosage considerations may apply to patients with conditions like diabetes, cardiovascular disease, or gastrointestinal disorders.

Clinical Use Cases This combination is not typically used in the settings of intubation, surgical procedures, mechanical ventilation, intensive care unit (ICU) use, or emergency situations. It primarily focuses on nutritional deficiencies.

Dosage Adjustments

Dose modifications are based on factors like renal/hepatic dysfunction, other medical conditions, response to therapy, and blood levels of iron, vitamin B12, and folate.

Side Effects

Common Side Effects

• Constipation
• Diarrhea
• Nausea
• Stomach upset
• Dark stools (harmless)

Rare but Serious Side Effects

• Allergic reactions (rash, itching, swelling, dizziness, difficulty breathing)
• Gastrointestinal bleeding (rare)

Long-Term Effects

Limited data is available on the chronic effects of this specific drug combination, though individually, the vitamins and iron can contribute to long-term health when taken appropriately.

Adverse Drug Reactions (ADR)

Clinically significant ADRs are rare but should be monitored, including hypersensitivity reactions and signs of gastrointestinal bleeding.

Contraindications

• Hypersensitivity to any component of the medication
• Hemochromatosis (iron overload disorder)
• Hemosiderosis (iron overload disorder)
• Certain types of anemia (hemolytic anemia)

Drug Interactions

• Antacids
• Antibiotics (e.g., tetracyclines, quinolones, chloramphenicol)
• Levodopa
• Anti-seizure medications (e.g., phenytoin)
• Levothyroxine
• Alcohol (reduces iron absorption)
• Dairy products and eggs (reduce iron absorption)

Pregnancy and Breastfeeding

This medication is generally considered safe during pregnancy and breastfeeding when taken as directed by a physician. It’s essential to consult with a doctor before using this combination, especially if you are pregnant, planning to become pregnant, or breastfeeding. Supplementation should ensure adequate levels for both maternal and fetal/infant health.

Drug Profile Summary

• Mechanism of Action: Replenishes iron, folate, and vitamin B12, vital for red blood cell formation and nerve function.
• Side Effects: Constipation, diarrhea, nausea, upset stomach, dark stools.
• Contraindications: Hypersensitivity, hemochromatosis, hemosiderosis, hemolytic anemia.
• Drug Interactions: Antacids, antibiotics, levodopa, anti-seizure medications, levothyroxine, alcohol.
• Pregnancy & Breastfeeding: Generally safe when used as directed by a physician.
• Dosage: As per physician’s prescription, typically one capsule or tablet daily.
• Monitoring Parameters: Hemoglobin, hematocrit, iron, vitamin B12, and folate levels.

Popular Combinations

This combination itself is a popular one, and it’s often combined with other vitamins and minerals, especially during pregnancy, as per the doctor’s advice.

Precautions

• Pre-existing medical conditions like liver or kidney disease should be reported to the doctor.
• Alcohol should be avoided or limited, as it can interfere with iron absorption.
• Dosage recommendations should be followed strictly.
• Allergic reactions should be reported immediately.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Ferrous asparto glycinate + L-Methyl Folate + Methylcobalamin?

A: The standard dosage for adults is typically one capsule or tablet daily, but this may vary based on individual needs and the severity of deficiency. A pediatrician should determine the appropriate dosage for children.

Q2: What are the primary uses of this combination?

A: It is primarily used to treat and prevent nutritional deficiencies, particularly iron-deficiency anemia and megaloblastic anemia. It is often prescribed during pregnancy for iron and folate supplementation.

Q3: Are there any significant drug interactions I should be aware of?

A: Yes, this combination can interact with antacids, antibiotics, levodopa, anti-seizure medications, and levothyroxine. Alcohol, dairy products, and eggs can also reduce iron absorption.

Q4: Can this combination be taken during pregnancy and breastfeeding?

A: Generally, it is considered safe during pregnancy and breastfeeding when used as directed by a doctor. However, it’s crucial to consult a physician before starting any new medication during these periods.

Q5: What are the most common side effects?

A: The most common side effects are gastrointestinal issues, including constipation, diarrhea, nausea, and upset stomach. Dark stools may occur but are generally harmless.

Q6: Are there any serious side effects I should be aware of?

A: While rare, allergic reactions and gastrointestinal bleeding can occur. Seek immediate medical attention if these occur.

Q7: How should this medication be stored?

A: Store the medication in a cool, dry place away from direct sunlight and out of reach of children.

Q8: How does this combination affect patients with renal or hepatic impairment?

A: Dose adjustments may be necessary for patients with kidney or liver problems. It’s important to inform the doctor about any pre-existing medical conditions.

Q9: What should I do if I miss a dose?

A: If you miss a dose, take it as soon as you remember. If it’s near the time for your next dose, skip the missed dose and return to your regular dosing schedule. Do not double the dose to catch up.

Q10: What monitoring parameters are relevant for this drug?

A: Hemoglobin, hematocrit, iron, vitamin B12, and folate levels should be monitored regularly to assess the effectiveness of the treatment and adjust the dosage as needed.