Usage
- Ferrous bisglycinate is primarily prescribed for the prevention and treatment of iron deficiency and iron deficiency anemia. It is particularly beneficial for individuals who experience gastrointestinal side effects with other iron supplements.
- Pharmacological classification: Hematinic, mineral supplement.
- Mechanism of Action: Ferrous bisglycinate provides a bioavailable form of iron, an essential component of hemoglobin, myoglobin, and various enzymes. Hemoglobin is crucial for oxygen transport in red blood cells, while myoglobin facilitates oxygen storage in muscle tissues. Iron is also involved in numerous metabolic processes.
Alternate Names
- Iron bisglycinate chelate, ferrous glycinate, iron glycinate.
- Brand names vary depending on the manufacturer. Some examples may be Ferrochel or other regional brand names.
How It Works
- Pharmacodynamics: Ferrous bisglycinate replenishes depleted iron stores, which is essential for the synthesis of hemoglobin and myoglobin. This results in increased red blood cell count and improved oxygen-carrying capacity.
- Pharmacokinetics:
- Absorption: Ferrous bisglycinate is absorbed in the duodenum and upper jejunum. Its absorption is enhanced by the presence of amino acids, particularly glycine, which facilitate its transport across the intestinal mucosa. It is less affected by dietary factors (phytates, tannins) compared to inorganic iron salts.
- Metabolism: Absorbed iron is transported via transferrin to bone marrow for erythropoiesis or stored as ferritin and hemosiderin in the liver, spleen, and bone marrow.
- Elimination: Iron is primarily eliminated through blood loss (menstruation, injury), with minimal excretion via urine, feces, and sweat.
- Mode of action: Iron from ferrous bisglycinate is released and becomes available for use in hemoglobin synthesis and other iron-dependent metabolic processes.
Dosage
Standard Dosage
Adults:
- The standard dose ranges from 15 mg to 120 mg of elemental iron daily, typically divided into two doses. Dosage is determined by the severity of iron deficiency and individual tolerance.
Children:
- Dosing in children is based on weight, typically ranging from 3 mg to 6 mg of elemental iron per kg of body weight daily, up to a maximum of 30 mg daily, usually divided into multiple doses.
- Pediatric safety considerations include close monitoring for potential overdose, especially in young children. Iron supplements should be kept out of reach of children.
Special Cases:
- Elderly Patients: Dosage adjustments may be needed based on kidney function and the presence of comorbidities.
- Patients with Renal Impairment: Dose reduction may be necessary depending on the degree of renal impairment.
- Patients with Hepatic Dysfunction: Caution is advised, and dose adjustment might be required.
- Patients with Comorbid Conditions: Considerations for diabetes, cardiovascular disease, and other conditions should be made when determining dosage.
Clinical Use Cases
Ferrous bisglycinate is primarily used for oral iron supplementation in the outpatient setting. It is not typically administered in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations. In these situations, intravenous iron preparations are usually preferred for rapid and efficient iron delivery.
Dosage Adjustments
- Dose adjustments are based on patient-specific factors like renal function, liver function, other medical conditions, and tolerance to the medication.
- Genetic polymorphisms affecting iron metabolism should also be considered.
Side Effects
Common Side Effects
- Constipation
- Nausea
- Diarrhea
- Dark stools
- Stomach upset
Rare but Serious Side Effects
- Allergic reactions (rash, itching, swelling)
Long-Term Effects
- Iron overload (in cases of prolonged high-dose use or underlying conditions affecting iron metabolism)
Adverse Drug Reactions (ADR)
- Severe allergic reactions (anaphylaxis) - requires immediate medical intervention.
Contraindications
- Hemochromatosis
- Hemosiderosis
- Known hypersensitivity to ferrous bisglycinate
Drug Interactions
- Antacids
- Tetracycline antibiotics
- Quinolone antibiotics
- Levothyroxine
- Levodopa
- Bisphosphonates
- Calcium, magnesium, and zinc supplements
Pregnancy and Breastfeeding
- Ferrous bisglycinate can be used during pregnancy and breastfeeding to treat iron deficiency. It’s generally considered safe when taken at recommended doses. However, it is crucial to consult with a doctor for personalized advice and dosage recommendations.
Drug Profile Summary
- Mechanism of Action: Replenishes iron stores, essential for hemoglobin, myoglobin, and enzyme synthesis.
- Side Effects: Constipation, nausea, diarrhea, dark stools, stomach upset. Rarely: allergic reactions.
- Contraindications: Hemochromatosis, hemosiderosis, hypersensitivity to ferrous bisglycinate.
- Drug Interactions: Antacids, tetracycline/quinolone antibiotics, levothyroxine, levodopa, bisphosphonates, Ca/Mg/Zn supplements.
- Pregnancy & Breastfeeding: Generally safe for use when needed and prescribed. Consult a doctor.
- Dosage: Adults: 15-120 mg elemental iron daily (divided doses). Children: 3-6 mg/kg/day (up to 30 mg/day).
- Monitoring Parameters: Hemoglobin, ferritin, iron levels, and other relevant blood parameters.
Popular Combinations
- Ferrous bisglycinate is often combined with folic acid, especially during pregnancy, to support red blood cell production and fetal development.
- It may also be combined with other vitamins and minerals, such as Vitamin C, Vitamin B12, or multivitamins, based on individual needs.
Precautions
- General Precautions: Assess iron status, renal and liver function before initiating therapy. Monitor for potential side effects.
- Specific Populations:
- Pregnant Women: Monitor iron levels closely.
- Breastfeeding Mothers: Supplement as needed under the guidance of a healthcare professional.
- Children & Elderly: Use age-appropriate formulations and dosing.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ferrous Bisglycinate?
A: Adults: 15-120 mg of elemental iron daily, divided into two doses. Children: 3-6 mg/kg/day, divided doses (up to 30 mg/day).
Q2: What are the common side effects of Ferrous Bisglycinate?
A: Constipation, nausea, diarrhea, stomach upset, and dark stools.
Q3: How is Ferrous Bisglycinate different from other iron supplements like ferrous sulfate?
A: Ferrous bisglycinate is generally better tolerated and has higher bioavailability, resulting in fewer gastrointestinal side effects and potentially lower required doses compared to ferrous sulfate.
Q4: Can Ferrous Bisglycinate be taken during pregnancy?
A: Yes, but under the supervision of a physician for proper dosing and monitoring.
Q5: What are the contraindications for Ferrous Bisglycinate?
A: Hemochromatosis, hemosiderosis, and known hypersensitivity.
Q6: Are there any drug interactions I should be aware of with Ferrous Bisglycinate?
A: Yes, it interacts with antacids, certain antibiotics, levothyroxine, levodopa, bisphosphonates, and calcium, magnesium, or zinc supplements.
Q7: What should I do if a patient experiences adverse effects?
A: Assess the severity of the side effects. Consider dose adjustment, switching to an alternative iron supplement, or managing the side effects symptomatically. For severe allergic reactions, seek immediate medical attention.
Q8: How should I monitor a patient on Ferrous Bisglycinate therapy?
A: Monitor hemoglobin, ferritin, and iron levels regularly to assess the response to treatment and guide dosage adjustments.
Q9: How should Ferrous Bisglycinate be taken?
A: Ideally, take it on an empty stomach for optimal absorption. However, if it causes gastrointestinal upset, it can be taken with or after food. Taking it with vitamin C-rich foods can enhance absorption. Avoid taking it simultaneously with antacids or other interfering medications.
