Usage
- Ferrous fumarate is primarily prescribed for the prevention and treatment of iron deficiency anemia. This condition arises from inadequate iron levels, crucial for hemoglobin synthesis and oxygen transport.
- Pharmacological Classification: Hematinic, Mineral Supplement.
- Mechanism of Action: Ferrous fumarate provides a source of iron, an essential component of hemoglobin. Hemoglobin, found in red blood cells, carries oxygen from the lungs to the rest of the body. Supplemental iron replenishes depleted iron stores, enabling the production of red blood cells and hemoglobin to correct anemia and restore oxygen-carrying capacity.
Alternate Names
- Iron(II) fumarate
- No widely used International or regional variations exist.
- Brand Names: Ferretts, Ferrimin 150, Hemocyte, Ferrograd, Fersamal, Ferro-Gradumet. (Please note that brand names may vary by region.)
How It Works
- Pharmacodynamics: Ferrous fumarate elevates serum iron levels, promoting erythropoiesis (red blood cell formation) and increasing hemoglobin concentration. This corrects the oxygen deficit associated with anemia, improving tissue oxygenation and reversing symptoms like fatigue and pallor.
- Pharmacokinetics:
- Absorption: Primarily absorbed in the duodenum and upper jejunum. Absorption is enhanced in iron-deficient states and reduced by food, antacids, and certain medications (e.g., tetracyclines, quinolones).
- Metabolism: Iron is transported by transferrin and stored as ferritin or hemosiderin. Excess iron can accumulate in tissues, potentially leading to toxicity.
- Elimination: Primarily excreted through intestinal mucosal sloughing and minor losses via urine, sweat, and menstruation.
- Mode of Action: Ferrous iron (Fe2+) from ferrous fumarate is incorporated into the heme molecule, a crucial component of hemoglobin. Hemoglobin binds oxygen in the lungs and releases it to tissues throughout the body.
- No specific receptor binding, enzyme inhibition, or neurotransmitter modulation is associated with ferrous fumarate’s primary action.
- Elimination pathways: Minimal renal excretion, primarily eliminated via intestinal mucosal sloughing, with minor losses in urine, sweat, and menstruation.
Dosage
Standard Dosage
Adults:
- Treatment of Iron Deficiency Anemia: 100-200 mg elemental iron per day (equivalent to approximately 300-600 mg ferrous fumarate), divided into 1-3 doses.
- Prevention of Iron Deficiency Anemia: 60-120 mg elemental iron per day (equivalent to approximately 180-360 mg ferrous fumarate).
Children:
- Treatment: 3-6 mg elemental iron/kg/day, divided into 2-3 doses (maximum 180 mg elemental iron daily).
- Prophylaxis: Dosage varies based on age and individual needs; consult pediatric guidelines.
- Pediatric Safety Considerations: Keep out of reach of children due to the risk of iron toxicity from overdose. Liquid formulations can stain teeth; administer with a straw or dropper and encourage rinsing the mouth afterward.
Special Cases:
- Elderly Patients: Start with lower doses and titrate based on tolerance and response. Consider underlying gastrointestinal conditions that may affect absorption.
- Patients with Renal Impairment: No specific dose adjustment is usually needed but monitor closely. Intravenous iron may be considered for patients with chronic kidney disease undergoing dialysis.
- Patients with Hepatic Dysfunction: Use cautiously and monitor liver function tests. Dose adjustment may be necessary in severe hepatic impairment.
- Patients with Comorbid Conditions: Adjust dosage as needed for concomitant medications or conditions that affect iron absorption or metabolism (e.g., inflammatory bowel disease).
Clinical Use Cases Intubation, surgical procedures, mechanical ventilation, and ICU use do not typically necessitate specific ferrous fumarate dosing adjustments. Address underlying anemia and iron deficiency. Emergency situations like cardiac arrest or status epilepticus do not have specific ferrous fumarate indications.
Dosage Adjustments
Adjustments may be required based on individual patient response, tolerance to gastrointestinal side effects, and co-administered medications.
Side Effects
Common Side Effects
- Constipation
- Diarrhea
- Nausea
- Dark stools
- Abdominal discomfort
Rare but Serious Side Effects
- Allergic reactions (e.g., hives, difficulty breathing, swelling)
- Severe gastrointestinal upset (e.g., persistent vomiting, severe abdominal pain)
- Iron overload (with prolonged high-dose therapy)
Long-Term Effects
- Iron overload (hemosiderosis, hemochromatosis) with excessive or prolonged use
Adverse Drug Reactions (ADR)
- Allergic reactions (require immediate intervention)
Contraindications
- Hemochromatosis
- Hemosiderosis
- Hemolytic anemia (unless iron deficiency coexists)
- Hypersensitivity to ferrous fumarate
Drug Interactions
- Antacids (reduce iron absorption)
- Tetracyclines, quinolones, levodopa, penicillamine, levothyroxine, bisphosphonates (reduced absorption of these medications)
- Ciprofloxacin (significantly reduced bioavailability)
- Ascorbic acid (vitamin C) increases iron absorption.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: A (generally considered safe for use during pregnancy under the supervision of a healthcare professional).
- Breastfeeding: Generally compatible with breastfeeding.
Drug Profile Summary
- Mechanism of Action: Replenishes iron stores, facilitating hemoglobin synthesis and correcting iron deficiency anemia.
- Side Effects: Constipation, diarrhea, nausea, dark stools, abdominal discomfort.
- Contraindications: Hemochromatosis, hemosiderosis, hemolytic anemia (unless concomitant iron deficiency), hypersensitivity.
- Drug Interactions: Antacids, tetracyclines, quinolones, bisphosphonates, levodopa, penicillamine, levothyroxine, ciprofloxacin.
- Pregnancy & Breastfeeding: Generally safe during pregnancy and breastfeeding. Monitor iron levels and consult guidelines.
- Dosage: Adults (Treatment): 100-200 mg elemental iron/day; Children: 3-6 mg elemental iron/kg/day. Dosage adjustments may be needed.
- Monitoring Parameters: Hemoglobin, hematocrit, ferritin, iron levels, transferrin saturation.
Popular Combinations
- Ferrous Fumarate + Folic Acid: Often combined, especially during pregnancy, to address concurrent folate deficiency and support red blood cell production.
Precautions
- Assess for pre-existing conditions like hemochromatosis, peptic ulcers, and gastrointestinal disorders.
- Monitor hemoglobin, hematocrit, and iron levels during therapy.
- Counsel patients on potential gastrointestinal side effects and strategies to manage them (e.g., taking with food, adjusting dosage).
- Advise pregnant women and breastfeeding mothers about recommended iron intakes.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ferrous Fumarate?
A: Adults: 100-200 mg elemental iron per day for treatment, 60-120 mg for prevention. Children: 3-6 mg elemental iron/kg/day. Dosage needs to be adjusted for specific patient conditions.
Q2: What are the common side effects of Ferrous Fumarate?
A: Common side effects include constipation, diarrhea, nausea, dark stools, and abdominal discomfort.
Q3: Can Ferrous Fumarate be taken during pregnancy?
A: Yes, ferrous fumarate is generally considered safe during pregnancy. However, close monitoring of iron levels and consultation with a healthcare professional are necessary.
Q4: How should Ferrous Fumarate be taken?
A: It should be taken on an empty stomach, preferably one hour before or two hours after a meal, with water or fruit juice (not milk or tea). Taking it with food can reduce gastrointestinal side effects but may decrease absorption slightly.
Q5: What are the signs of iron overload?
A: Signs of iron overload may include fatigue, joint pain, abdominal pain, and skin discoloration. Regular monitoring of iron levels is important during long-term ferrous fumarate therapy.
Q6: How long does it take for Ferrous Fumarate to start working?
A: Hemoglobin levels usually start to rise within a few weeks of starting ferrous fumarate, but it can take several months for iron stores to be fully replenished.
Q7: What should I do if I miss a dose of Ferrous Fumarate?
A: If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose. Do not double up on doses.
Q8: Are there any drug interactions I should be aware of with Ferrous Fumarate?
A: Yes, several drugs can interact with ferrous fumarate. Consult the drug interaction section or your healthcare provider before starting any new medications.
Q9: Can ferrous fumarate stain teeth?
A: Liquid formulations of ferrous fumarate can stain teeth. Administer with a straw or dropper, encourage rinsing afterward, and maintain good oral hygiene.
Q10: Can I take ferrous fumarate with antacids?
A: No, antacids can reduce iron absorption and should not be taken at the same time as ferrous fumarate. Separate administration by at least two hours.
