Usage
Ferrous ascorbate is prescribed for the treatment and prevention of iron deficiency anemia. It is also used to address iron deficiency in conditions like menorrhagia (heavy menstrual bleeding) and during pregnancy to prevent conditions like pre-eclampsia (pregnancy-induced hypertension) and neural tube defects in the developing fetus when combined with folic acid. It is classified as a hematinic and anti-anemic agent.
The mechanism of action involves providing supplemental iron, essential for hemoglobin synthesis and oxygen transport. Ascorbic acid (vitamin C) component enhances iron absorption in the gut.
Alternate Names
No widely used alternate names for ferrous ascorbate exist. Brand names may vary regionally; some examples include Orofer-XT (often combined with folic acid).
How It Works
Pharmacodynamics: Ferrous ascorbate increases serum iron levels, which are essential for hemoglobin formation within red blood cells. Hemoglobin binds and transports oxygen throughout the body. Ascorbate promotes iron absorption by reducing ferric iron (Fe3+) to ferrous iron (Fe2+), the form more readily absorbed in the duodenum and upper jejunum.
Pharmacokinetics:
- Absorption: Iron from ferrous ascorbate is absorbed primarily in the duodenum and upper jejunum. Ascorbic acid enhances this absorption significantly compared to other iron salts like ferrous sulfate.
- Distribution: Absorbed iron binds to transferrin, a transport protein in the blood, and is distributed to the liver, spleen, and bone marrow for utilization and storage.
- Metabolism & Elimination: Iron is not extensively metabolized but rather incorporated into hemoglobin or stored as ferritin or hemosiderin. A small amount (around 1 mg) of endogenous iron is eliminated daily through urine, skin, and feces. Excess iron is not readily excreted, leading to a potential risk of accumulation in conditions of iron overload.
Dosage
Dosage guidelines vary depending on the severity of iron deficiency, age, and other patient-specific factors. Always consult a doctor for personalized dosage recommendations.
Standard Dosage
Adults: A common dose for treating iron deficiency anemia is 100-200 mg of elemental iron per day, often administered as a single dose or divided into two or three doses. For prevention, 65 mg of elemental iron daily is sometimes recommended.
Children: Pediatric dosing is weight-based, typically 3-6 mg of elemental iron per kg of body weight daily, divided into three doses. The maximum daily dose should generally not exceed 200 mg. Premature infants and young children require careful dosage adjustments based on their specific needs and medical condition.
Special Cases:
- Elderly Patients: Similar to adults, starting with a lower dose and gradually increasing may be advisable to minimize gastrointestinal side effects.
- Patients with Renal Impairment: Dose adjustment might be necessary depending on the degree of impairment.
- Patients with Hepatic Dysfunction: No specific dosage adjustments are typically required.
- Patients with Comorbid Conditions: Consider individual patient factors like gastrointestinal disorders which may influence dosage or require co-administration of medications to manage side effects.
Clinical Use Cases
Ferrous ascorbate is primarily used for iron deficiency anemia, not generally indicated for conditions like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Dose adjustments are made based on patient response to therapy, monitoring hemoglobin and other hematological parameters. Reduce dosage if gastrointestinal side effects are significant.
Side Effects
Common Side Effects:
Constipation, diarrhea, dark stools (harmless), nausea, stomach upset.
Rare but Serious Side Effects:
Allergic reactions (rash, itching, swelling).
Long-Term Effects:
Iron overload (with prolonged high doses or in patients with certain genetic conditions) may lead to organ damage.
Adverse Drug Reactions (ADR)
Severe allergic reactions (rare).
Contraindications
- Hypersensitivity to iron or ascorbic acid.
- Hemochromatosis, hemosiderosis, or other iron overload conditions.
- Hemolytic anemia.
Drug Interactions
- Antacids, dairy products, tea, coffee: Reduce iron absorption.
- Tetracycline antibiotics, fluoroquinolones, levodopa, methyldopa, bisphosphonates: Reduced absorption of these medications.
- Chloramphenicol: May interfere with red blood cell development.
Pregnancy and Breastfeeding
Generally considered safe to use during pregnancy and breastfeeding under medical supervision. Folic acid is often combined with ferrous ascorbate during pregnancy to prevent neural tube defects.
Drug Profile Summary
- Mechanism of Action: Replenishes iron stores, enhances hemoglobin synthesis, and improves oxygen transport. Ascorbic acid enhances iron absorption.
- Side Effects: Constipation, diarrhea, dark stools, nausea, stomach upset. Rarely, allergic reactions.
- Contraindications: Iron overload conditions, hemolytic anemia, hypersensitivity.
- Drug Interactions: Antacids, dairy products, certain antibiotics, and other medications (as mentioned above).
- Pregnancy & Breastfeeding: Generally safe when used as directed.
- Dosage: Varies depending on age, condition, and individual needs. Consult a doctor.
- Monitoring Parameters: Hemoglobin, hematocrit, iron levels, and other relevant blood tests.
Popular Combinations
Ferrous ascorbate is frequently combined with folic acid, especially during pregnancy.
Precautions
- Pre-existing gastrointestinal disorders.
- History of allergy to iron or ascorbic acid.
- Monitor iron levels regularly to avoid overload.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ferrous Ascorbate?
A: The dosage varies, typically 100-200 mg of elemental iron per day for adults treating iron deficiency anemia. Pediatric dosing is weight-based (3-6 mg/kg/day). Consult a physician for individualised dosing.
Q2: What are the common side effects of Ferrous Ascorbate?
A: Common side effects include constipation, diarrhea, dark stools, nausea, and stomach upset.
Q3: Can I take Ferrous Ascorbate with food?
A: It’s best taken on an empty stomach for optimal absorption. If gastrointestinal upset occurs, you can take it with food.
Q4: Who should not take Ferrous Ascorbate?
A: Individuals with iron overload conditions (hemochromatosis, hemosiderosis), hemolytic anemia, or a hypersensitivity to iron should not take this medication.
Q5: Can pregnant women take Ferrous Ascorbate?
A: Yes, ferrous ascorbate is often recommended during pregnancy to treat or prevent iron deficiency anemia, usually combined with folic acid.
Q6: How long does it take for Ferrous Ascorbate to work?
A: Hemoglobin levels usually start to improve within a few weeks, but it may take several months to replenish iron stores fully.
Q7: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember. If it’s near the time for the next dose, skip the missed dose and return to your regular schedule. Do not double the dose.
Q8: Can Ferrous Ascorbate interact with other medications?
A: Yes, it can interact with antacids, certain antibiotics (tetracyclines, fluoroquinolones), levodopa, methyldopa, and bisphosphonates. It’s essential to inform your doctor about all other medications you are taking.
Q9: What is the difference between ferrous ascorbate and ferrous sulfate?
A: Both are iron supplements, but ferrous ascorbate is generally better absorbed due to the presence of ascorbic acid. This also tends to result in fewer gastrointestinal side effects.
