Usage
This combination is prescribed for the prevention and treatment of nutritional deficiency anemia, particularly iron-deficiency anemia. It addresses deficiencies in iron, folic acid, vitamin B12 (methylcobalamin), and zinc. It may also be used to support nerve function, boost immune response, aid wound healing, and prevent neural tube defects during pregnancy. It belongs to the class of dietary supplements or hematinics.
The mechanism of action involves providing the body with essential nutrients required for red blood cell production, DNA synthesis, nerve function, and immune function.
Alternate Names
No specific alternate generic names are available, but different manufacturers market it under various brand names. Some examples include: Bizfer-XT, Loadred Forte, Ferobik-DS, and Feroway Plus.
How It Works
Pharmacodynamics:
- Ferrous Bisglycinate: Replenishes iron stores, crucial for hemoglobin synthesis and oxygen transport. It is a more readily absorbed and tolerated form of iron.
- Folic Acid: Essential for DNA synthesis, red blood cell formation, and cell division. It is particularly important during pregnancy for neural tube development in the fetus. Folic acid, upon entering the body, is transformed into its active form tetrahydrofolic acid.
- Methylcobalamin: The active form of vitamin B12, is essential for nerve function, DNA synthesis, and red blood cell formation. It improves nerve health through participating in the methylation reaction involved in the synthesis of myelin.
- Zinc Bisglycinate: Supports immune function, wound healing, and overall cellular function. Zinc plays a crucial role in many enzymes in the body, and is important for immune cell function and wound healing.
Pharmacokinetics:
- Absorption: Ferrous bisglycinate is absorbed in the small intestine. Folic acid is absorbed primarily in the jejunum. Methylcobalamin and zinc bisglycinate are also absorbed in the gastrointestinal tract. The absorption of iron from ferrous bisglycinate is not affected by dietary factors and has better absorption than other iron salts.
- Metabolism: Folic acid is metabolized in the liver to tetrahydrofolic acid, its active form. Methylcobalamin is directly utilized by the body.
- Elimination: Iron is primarily eliminated through feces and minor quantities through urine and sweat. Folic acid is eliminated primarily in the urine. Methylcobalamin is also excreted in urine. Excess zinc is excreted through the feces.
Dosage
Standard Dosage
Adults:
One or two tablets daily, or as prescribed by the physician. It is generally recommended to take the supplement with a meal to enhance absorption and reduce potential gastrointestinal discomfort.
Children:
Dosage should be determined by a pediatrician based on the child’s age, weight, and clinical condition.
Special Cases:
- Elderly Patients: Dose adjustments may be necessary based on renal function and overall health status.
- Patients with Renal Impairment: Dosage modification is necessary depending on the degree of impairment. Consultation with a nephrologist is recommended.
- Patients with Hepatic Dysfunction: Close monitoring is recommended, but dose adjustments may not be required.
- Patients with Comorbid Conditions: Individualized dosing based on specific conditions (e.g., diabetes, cardiovascular disease) should be determined in consultation with specialists.
Clinical Use Cases
The primary clinical use is for managing nutritional deficiencies and not typically used in specific clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Side Effects
Common Side Effects
- Nausea
- Constipation
- Dark stools
- Metallic taste in the mouth
- Diarrhea
- Stomach upset
- Bloating
Rare but Serious Side Effects
Allergic reactions (rash, itching, swelling), though rare, require immediate medical attention.
Long-Term Effects
No specific long-term adverse effects have been consistently reported with this combination, but individual components may cause issues if taken in excess over a long period. Excessive iron intake can lead to iron overload (hemochromatosis).
Contraindications
- Hypersensitivity to any component of the formulation
- Hemochromatosis
- Hemosiderosis
- Other conditions affecting iron metabolism
Drug Interactions
- Antibiotics (tetracyclines, quinolones): Reduced absorption of iron and other minerals.
- Levothyroxine: Reduced levothyroxine absorption.
- Bisphosphonates: Reduced absorption of bisphosphonates.
- Antacids: Reduced absorption of iron.
- Levodopa: Reduced levodopa effects.
- Penicillamine: Reduced penicillamine absorption.
- Calcium supplements: Reduced absorption of both iron and calcium.
Pregnancy and Breastfeeding
Folic acid is crucial during pregnancy; however, consult a doctor before use, especially regarding iron and zinc intake. Data on the safety of the combination is limited.
Drug Profile Summary
- Mechanism of Action: Provides essential nutrients (iron, folic acid, vitamin B12, and zinc) for red blood cell production, DNA synthesis, nerve function, and immune function.
- Side Effects: Nausea, constipation, dark stools, metallic taste, diarrhea, stomach upset, bloating. Rarely, allergic reactions.
- Contraindications: Hypersensitivity, hemochromatosis, hemosiderosis.
- Drug Interactions: Antibiotics, levothyroxine, bisphosphonates, antacids, levodopa, penicillamine, calcium supplements.
- Pregnancy & Breastfeeding: Consult a doctor before use. Folic acid is essential during pregnancy.
- Dosage: Adults: 1-2 tablets daily with a meal. Pediatric and special population dosing should be determined by a healthcare professional.
- Monitoring Parameters: Hemoglobin, red blood cell count, iron levels, vitamin B12 levels, zinc levels (if clinically indicated).
Popular Combinations
This combination itself is a popular combination, and it’s not generally combined with other drugs.
Precautions
- General Precautions: Assess for allergies, pre-existing medical conditions (especially gastrointestinal, liver, and kidney conditions), and current medications.
- Pregnant Women: Consult a doctor before use.
- Breastfeeding Mothers: Consult a doctor before use.
- Children & Elderly: Dose adjustments may be necessary.
- Lifestyle Considerations: Limit consumption of tea or coffee around the time of taking the supplement. Dietary fiber intake should be increased to prevent constipation. Adequate hydration and regular exercise are important.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ferrous Bisglycinate + Folic Acid + Methylcobalamin + Zinc bisglycinate?
A: The standard adult dosage is 1-2 tablets daily, preferably with a meal. Pediatric dosages should be determined by a pediatrician.
Q2: Can this combination be taken during pregnancy?
A: While folic acid is crucial during pregnancy, consult a doctor before use, especially regarding iron and zinc intake.
Q3: What are the common side effects?
A: Common side effects include nausea, constipation, dark stools, metallic taste, diarrhea, stomach upset, and bloating.
Q4: Are there any drug interactions I should be aware of?
A: Yes, this combination can interact with certain medications like antibiotics, levothyroxine, bisphosphonates, antacids, and others. Inform your doctor about all medications you are currently taking.
Q5: Can this combination be taken on an empty stomach?
A: While it can be taken on an empty stomach, taking it with food can improve absorption and reduce potential gastrointestinal side effects.
Q6: How long does it take to see results?
A: The time to see improvement in symptoms of anemia varies depending on the severity of the deficiency and individual response. Regular monitoring of blood parameters is essential to assess treatment efficacy.
Q7: Can I stop taking this combination once my symptoms improve?
A: Do not discontinue without consulting your doctor. Your doctor will determine the appropriate duration of treatment based on your individual needs.
Q8: What should I do if I miss a dose?
A: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Do not double the dose to catch up.
Q9: What precautions should patients with kidney disease take?
A: Patients with renal impairment need dosage adjustments based on their kidney function. Consultation with a nephrologist is crucial.
A: Ferrous bisglycinate is generally better absorbed and tolerated than other iron salts, causing fewer gastrointestinal side effects like constipation. It is also less likely to be affected by dietary inhibitors of iron absorption.
