Usage
Iron Hydroxide Polymaltose (IPC) is prescribed for the treatment and prevention of iron deficiency and iron deficiency anemia. It is particularly useful in situations where oral ferrous iron supplements are not tolerated or are ineffective, such as in patients with gastrointestinal disorders or malabsorption. It can also be used in patients undergoing dialysis. It is classified as an antianemic medication and hematinic.
IPC provides a non-ionic form of iron. This complex gradually releases trivalent iron for absorption. It is designed to mimic the physiological absorption of dietary iron.
Alternate Names
Iron(III)-hydroxide polymaltose complex, Ferric hydroxide polymaltose, Iron polymaltose complex.
Brand names include Maltofer®, Ferrosig®, Orofer®, Ferrum Hausmann®, and others depending on the region.
How It Works
Pharmacodynamics: Iron is essential for hemoglobin synthesis and oxygen transport. IPC replenishes iron stores, leading to increased hemoglobin levels and improved oxygen-carrying capacity. This reverses the symptoms of anemia, such as fatigue and weakness.
Pharmacokinetics:
- Absorption: Orally administered IPC is absorbed primarily in the duodenum and jejunum via active transport. Absorption is enhanced when taken with food and is not significantly affected by common dietary factors that inhibit ferrous iron absorption.
- Distribution: Absorbed iron binds to transferrin for transport to the bone marrow for erythropoiesis (red blood cell production) and to other tissues for storage as ferritin and hemosiderin.
- Metabolism: Iron released from the complex is handled similarly to dietary iron. Unabsorbed iron is eliminated through the feces.
- Elimination: Very little iron is excreted from the body.
Mode of Action: Unlike ferrous iron salts, IPC does not release free iron ions. The iron in IPC is bound within the polymaltose complex. This complex is structurally similar to ferritin, the body’s natural iron storage protein. This allows controlled release of iron and prevents oxidative stress.
Receptor binding, enzyme inhibition, or neurotransmitter modulation: IPC’s primary mechanism is iron replenishment, not direct interaction with receptors, enzymes, or neurotransmitters.
Dosage
Dosage is individualized based on the severity of iron deficiency. Doses are expressed in terms of elemental iron.
Standard Dosage
Adults: 100-300 mg of elemental iron daily, taken as a single dose or in divided doses with or after meals.
Children:
- Infants <1 year: 25-50 mg elemental iron daily.
- Children 1-12 years: 50-100 mg elemental iron daily.
- Adolescents (12+ years): 100-300mg elemental iron daily.
- Premature infants: As prescribed by a hematologist or neonatologist, starting with a low dose (1-2.5 mg/kg/day).
Special Cases:
- Elderly Patients: Dosage adjustments are not typically necessary.
- Patients with Renal Impairment: For patients undergoing dialysis, IV administration is often required following specific protocols for dose and rate of administration.
- Patients with Hepatic Dysfunction: Exercise caution in patients with severe liver disease.
- Patients with Comorbid Conditions: No specific adjustments are generally required.
Clinical Use Cases
IPC is primarily administered orally. Intravenous administration is reserved for specific cases where oral iron is not possible, particularly in chronic kidney disease. Dosing and administration for IV IPC will be determined by a nephrologist.
Dosage Adjustments:
Dose modifications may be necessary for patients with impaired renal function, severe liver disease, or other conditions.
Side Effects
Common Side Effects:
Darkening of stool (harmless), diarrhea, constipation, nausea, abdominal pain, vomiting.
Rare but Serious Side Effects:
Allergic reactions (hypersensitivity, rash, itching), hypoglycemia.
Long-Term Effects: No significant long-term effects are associated with appropriate IPC use. Excessive iron intake can lead to iron overload (haemosiderosis).
Contraindications
- Hypersensitivity to iron polymaltose
- Iron overload (e.g., hemochromatosis, haemosiderosis)
- Anemias not caused by iron deficiency (e.g., hemolytic anemia, thalassemia, megaloblastic anemia due to vitamin B12 deficiency)
- Severe liver disease
- Conditions requiring regular blood transfusions (potential for iron overload).
Drug Interactions
- Antacids: May reduce iron absorption. Separate administration by at least 2 hours.
- Tetracyclines: May reduce mutual absorption. Administer with a 2-3 hour interval.
- Levodopa, Methyldopa, Penicillamine, Fluoroquinolones: IPC may reduce absorption of these medications. Administer at least 2 hours apart.
- Zinc salts: May reduce iron absorption.
- High doses of Ascorbic Acid: May increase iron absorption.
- Calcium supplements: May reduce iron absorption. Administer at least 2 hours apart.
No interactions are expected with food, unlike ferrous salts.
Pregnancy and Breastfeeding
IPC is generally considered safe during pregnancy and breastfeeding. It is often preferred over ferrous salts due to better tolerability. However, it is crucial to monitor iron levels and adjust dosage as needed. No adverse effects on the fetus have been reported with therapeutic doses. Iron does pass into breast milk, but in insufficient quantities to harm the infant.
Drug Profile Summary
- Mechanism of Action: Provides non-ionic iron for controlled release and absorption, mimicking physiological iron uptake.
- Side Effects: Generally well-tolerated; common side effects include darkened stool, constipation, and nausea.
- Contraindications: Iron overload, anemias not due to iron deficiency, hypersensitivity.
- Drug Interactions: Antacids, tetracyclines, certain medications (levodopa, methyldopa).
- Pregnancy & Breastfeeding: Generally safe, monitor iron levels.
- Dosage: Individualized based on needs; usual adult dose is 100-300mg elemental iron daily.
- Monitoring Parameters: Hemoglobin, hematocrit, ferritin, serum iron, transferrin saturation.
Popular Combinations
IPC is sometimes combined with folic acid, especially during pregnancy, to address concurrent folic acid deficiency.
Precautions
Monitor patients for allergic reactions, especially those with a history of allergies. Evaluate liver and kidney function in patients with pre-existing liver or kidney disease. Ensure correct diagnosis of iron deficiency anemia before initiating therapy. Counsel patients about the harmless darkening of stool. Keep out of reach of children.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Iron Hydroxide Polymaltose?
A: The dosage varies by age, condition, and individual response. Adults: 100-300 mg elemental iron/day, Children (1-12 years): 50-100 mg elemental iron/day, Infants: 25-50 mg elemental iron/day.
Q2: How is Iron Hydroxide Polymaltose different from ferrous sulfate?
A: IPC is a non-ionic iron complex, better tolerated, and less affected by food interactions compared to ferrous sulfate, which is an ionic iron salt.
Q3: Can Iron Hydroxide Polymaltose be taken with food?
A: Yes, it can, and absorption is even enhanced when taken with meals.
Q4: Is Iron Hydroxide Polymaltose safe during pregnancy?
A: Generally, yes. It is often preferred due to fewer gastrointestinal side effects. Monitor iron levels and adjust dosage as needed.
Q5: What are the common side effects of Iron Hydroxide Polymaltose?
A: The most common side effect is a harmless darkening of stool. Some patients might experience mild constipation, diarrhea, nausea, or abdominal discomfort.
Q6: How long does it take for Iron Hydroxide Polymaltose to work?
A: It can take several weeks to months to replenish iron stores fully and resolve anemia symptoms. Regular monitoring of blood parameters is essential.
Q7: Are there any drug interactions I should be aware of with Iron Hydroxide Polymaltose?
A: Yes, avoid concurrent administration with antacids, tetracyclines, and some other medications (e.g., levodopa). Separate administration by at least 2 hours.
Q8: Can Iron Hydroxide Polymaltose be given intravenously?
A: Yes, IV administration is typically reserved for patients with chronic kidney disease on dialysis when oral iron is ineffective or not tolerated. Specific protocols are followed for IV administration.
Q9: What should I monitor in patients taking Iron Hydroxide Polymaltose?
A: Monitor hemoglobin, hematocrit, ferritin, serum iron, transferrin saturation, and clinical symptoms of anemia to assess response to therapy.
As of February 16, 2025, this information is current, but it is essential to refer to the latest medical guidelines and resources for the most up-to-date recommendations.
