Usage
Folic acid combined with sodium feredetate is primarily prescribed for the treatment and prevention of iron-deficiency anemia, particularly during pregnancy and lactation. It is also used to address nutritional deficiencies related to iron and folate. This combination medication is classified as a hematinic and nutritional supplement.
The mechanism of action involves providing a readily available source of iron (sodium feredetate) for hemoglobin synthesis and replenishing folate stores, which are essential for red blood cell formation and DNA synthesis.
Alternate Names
While “Folic acid + Sodium Feredetate” is the common generic name, some formulations may also include vitamin B12. Brand names vary depending on the manufacturer and specific formulation. Some examples include Feretate, Lycofer, and Hemoforce Forte.
How It Works
Pharmacodynamics: Sodium feredetate, a stable iron complex, is absorbed in the duodenum and jejunum. It delivers iron for incorporation into hemoglobin, the oxygen-carrying protein in red blood cells. Folic acid is converted to its active form, tetrahydrofolic acid, which is crucial for DNA synthesis, cell division, and red blood cell maturation. Vitamin B12, if present in the formulation, works synergistically with folic acid in these processes.
Pharmacokinetics: Sodium feredetate is absorbed more readily than other iron salts and has less gastrointestinal irritation. Absorption is enhanced when taken between meals and with vitamin C. It’s important to avoid co-administration with antacids, milk, tea, or coffee, which can hinder iron absorption. Folic acid is absorbed primarily in the jejunum. Both iron and folic acid are metabolized in the liver. Iron is stored as ferritin and hemosiderin, while excess folic acid is excreted in the urine. Iron excretion is minimal.
Dosage
Standard Dosage
Special Cases:
- Elderly Patients: Dosage should be initiated cautiously, usually starting at the lower end of the adult range and adjusted according to renal function.
- Patients with Renal Impairment: Dose adjustments are required based on creatinine clearance.
- Patients with Hepatic Dysfunction: Use with caution and monitor liver function tests.
- Patients with Comorbid Conditions: Consider the impact of comorbidities like diabetes, cardiovascular disease, inflammatory bowel disease, and peptic ulcer disease when determining the appropriate dosage and monitoring.
Clinical Use Cases
The use of Folic Acid + Sodium Feredetate in specific medical settings like intubation, surgical procedures, mechanical ventilation, or emergency situations should be guided by individual patient requirements and is not routinely part of standardized protocols for these scenarios. Iron and folate supplementation might be considered part of overall nutritional support based on patient needs.
Dosage Adjustments
Dose adjustments should be based on the patient’s response to therapy, hemoglobin levels, and iron status. For patients with renal or hepatic impairment, appropriate modifications are necessary.
Side Effects
Common Side Effects
Constipation, diarrhea, nausea, dark stools (harmless), and stomach upset are the common side effects.
Rare but Serious Side Effects
Allergic reactions (rash, itching, difficulty breathing), iron overload (in individuals with hemochromatosis), gastrointestinal bleeding.
Long-Term Effects
Long-term high doses of iron can lead to iron overload. Masking of vitamin B12 deficiency might occur with high doses of folic acid.
Adverse Drug Reactions (ADR)
Severe allergic reactions, iron toxicity.
Contraindications
Hypersensitivity to any component of the drug, iron overload disorders (hemochromatosis, hemosiderosis), anemias not caused by iron deficiency.
Drug Interactions
Antacids, antibiotics (tetracyclines, chloramphenicol), anticonvulsants (phenytoin), levodopa, quinolone antibiotics, thyroid medications, bisphosphonates, dairy products, eggs, tea, and coffee can decrease iron absorption. Alcohol can interact with sodium feredetate.
Pregnancy and Breastfeeding
This combination is generally considered safe during pregnancy and breastfeeding when used as directed. However, it’s essential to consult with a healthcare professional for proper dosage and monitoring.
Drug Profile Summary
- Mechanism of Action: Provides iron for hemoglobin synthesis and folate for red blood cell formation.
- Side Effects: Constipation, diarrhea, nausea, dark stools, stomach upset, allergic reactions (rare).
- Contraindications: Iron overload, hypersensitivity.
- Drug Interactions: Antacids, antibiotics, anticonvulsants, and certain foods.
- Pregnancy & Breastfeeding: Generally safe under supervision.
- Dosage: Varies based on age, condition, and formulation.
- Monitoring Parameters: Hemoglobin, iron levels.
Popular Combinations
Common combinations include the addition of Vitamin B12 and other essential vitamins and minerals.
Precautions
- General Precautions: Assess for allergies, underlying conditions, and potential drug interactions.
- Specific Populations: Pregnant women should be monitored for iron status.
- Lifestyle Considerations: Avoid alcohol, tea, and coffee near dosing times.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Folic Acid + Sodium Feredetate?
A: The dosage varies according to the age, condition, and formulation of the medication. Adult dosages often range from one tablet/capsule daily to 10-15ml of liquid formulation one to three times daily. Pediatric dosages are weight-based, with lower volumes administered to infants and younger children.
Q2: Can Folic Acid + Sodium Feredetate be taken during pregnancy?
A: Yes, this combination is generally considered safe during pregnancy and is often prescribed to address iron and folate deficiencies common during this period. However, it’s crucial to consult with a doctor for appropriate dosage and monitoring.
Q3: What are the common side effects?
A: Common side effects include constipation, diarrhea, nausea, dark stools (harmless), and stomach upset.
Q4: Are there any drug interactions I should be aware of?
A: Yes, several medications can interact with Folic Acid + Sodium Feredetate, including antacids, certain antibiotics, anticonvulsants, and thyroid medications. Certain foods, like dairy products, eggs, tea, and coffee, can also hinder iron absorption.
Q5: How should sodium feredetate be administered?
A: Sodium feredetate is typically taken orally, ideally between meals with water or fruit juice to maximize absorption. Avoid administering it with antacids, milk, tea, or coffee. Liquid formulations should be measured accurately using appropriate measuring devices.
Q6: What is the role of folic acid in this combination?
A: Folic acid plays a vital role in preventing and treating folate deficiency anemia, supporting red blood cell production, and ensuring healthy cell division and growth.
Q7: What are the signs of iron overload?
A: Signs of iron overload can include fatigue, joint pain, abdominal pain, and skin discoloration (bronzing or graying). Regular monitoring of iron levels is important during long-term treatment.
Q8: Can I take this medication if I have kidney disease?
A: Patients with kidney disease should use this combination with caution. Dose adjustments are typically required based on the severity of renal impairment. Close monitoring of renal function and iron status is crucial.
Q9: Should I take this medication on an empty stomach?
A: While absorption can be enhanced when taken between meals, it can sometimes cause gastrointestinal upset. If this occurs, it can be taken with food.
Q10: How long does it take to see improvement in iron deficiency anemia after starting this medication?
A: An improvement in symptoms and hemoglobin levels can often be observed within a few weeks of starting the medication, but full recovery may take several months.
