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THE INFORMATION IN THE OBPHARMACOPOEIATM
IS INTENDED SOLELY FOR USE BY THE MEDICAL PROFESSION. IT IS NOT INTENDED FOR LAY PERSONS.
FOCUS INFORMATION TECHNOLOGY, INC. DOES NOT ASSUME ANY RESPONSIBILITY FOR ANY ASPECT OF
HEALTHCARE ADMINISTERED WITH THE AID OF THIS CONTENT. THE PRESCRIBING PHYSICIAN
MUST BE FAMILIAR WITH THE FULL PRODUCT LABELING AS PROVIDED BY THE MANUFACTURER AND RELEVANT MEDICAL LITERATURE PRIOR TO USING THE OBPHARMACOPOEIATM
.
Oral Iron Therapy
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Accidental overdose of iron-containing products is a leading cause of fatal
poisoning in children younger than 6 years.
US national poison hotline at 1-800-222-1222
Web Site: www.poison.org
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The Centers for Disease Control (CDC) recommends low-dose iron supplementation (30 mg/d) from the first prenatal visit and
encouraging iron-rich foods [4]. However, taking iron before 20 weeks can worsen the nausea and vomiting of pregnancy in some women.
Ferrous sulfate (Feosol,Fer-In-Sol ® Syrup)
Available over the counter (OTC)
- Treatment of low blood levels of iron.
325 mg orally three times daily between meals separately from other medications
OR
10 mL syrup orally three times daily between meals
separately from other medications.
An increase in the hemoglobin concentration of at least 2 g/dL after 3 weeks of
therapy generally is used as the criterion for an adequate therapeutic response
[5]
Contraindicated in: Hemosiderosis, hemochromatosis, and
hemolytic anemia.
Ferrous sulfate reduces absorption of levothyroxine and methyldopa [6,7]
Gastrointestinal side effects including nausea, constipation, diarrhea and
abdominal pain are dose related.Docusate 100 mg bid may be given to reduce constipation.
(325 mg (65 mg elemental iron) tablets, 150 mg (30 mg elemental iron)per 5 mL syrup -250 mL bottle)
Carbonyl Iron (Feosol Caplet). Available over the counter (OTC)
This form of iron may be less toxic than iron salts. However
bioavailability is about 70% of ferrous sulfate [8-11].
- Treatment of low blood levels of iron .
45 mg orally three to four times daily between meals separately from other medications
An increase in the hemoglobin concentration of at least 2 g/dL after 3 weeks of
therapy generally is used as the criterion for an adequate therapeutic response
[5]
Contraindicated in: Hemosiderosis, hemochromatosis, and
hemolytic anemia.
Ferrous sulfate reduces absorption of levothyroxine and methyldopa [6,7].
Gastrointestinal side effects including nausea, constipation, diarrhea and
abdominal pain are dose related. Docusate 100 mg bid may be given to reduce constipation.
(45 mg (45 mg elemental iron) caplets )
Parenteral Iron Therapy
Indications for the use of intravenous iron include intestinal malabsorption, intolerance to oral iron, nonadherence,
or a hemoglobin level less than 6 g per dL (60 g per L) with signs of poor
perfusion in patients who would otherwise receive transfusion (e.g., those who
have religious objections) [12,13]. Consider evaluating for celiac disease in
patients refractory to oral iron therapy [14,15].
The dose of iron to give may be calculated using the
Iron Deficit Calculator
Iron Sucrose Injection (Venofer® )
Molecular weight: 34,000 – 60,000 daltons
- Treatment of low blood levels of iron in patients with chronic kidney
disease, intestinal malabsorption, or intolerance to oral iron.
200 mg diluted in
a maximum of 100 mL 0.9% Sodium Chloride given as a slow
intravenous infusion administered over at least 30 minutes one to three times per week [17].
For first dose of Venofer infuse a test dose of 25 g over 15 minutes . If
there is no adverse such as hives, wheezing, shortness of breath, or
hypotension, then continue infusion to complete over one hour. [19]
Do not dilute to concentrations below 1 mg/mL.
WARNINGS AND PRECAUTIONS
Observe for signs and symptoms of hypersensitivity
during and after Venofer administration for at least 30 minutes and until
clinically stable following completion of each administration. Only administer Venofer when personnel and therapies are immediately available for the treatment
of serious hypersensitivity reactions.
If wheezing, SOB, hypotension, or hives occurs stop infusion call
rapid response, and MD.
For anaphylactic reactions (hives, flushing, wheezing, shortness of
breath, chest pain, tachycardia hypotension, etc) see
Initial Treament
of Anaphylactic Reaction
Venofer® may cause clinically significant hypotension. Monitor for
signs and symptoms of hypotension following each administration of Venofer®.
Hypotension following administration of Venofer® may be related to rate of
administration and total dose delivered.
Contraindications: Known hypersensitivity to iron sucrose , evidence of iron overload (ferritin > 800 ng/mL and/or TSAT > 50%),
anemia not caused by iron deficiency, or evidence of severe infection (such as sepsis or osteomyelitis)
(2. 5 mL vial contains 50 mg elemental iron (20 mg/mL)5 mL vial contains 100 mg elemental iron (20 mg/mL), 10 mL vial contains 200 mg elemental iron (20 mg/mL))
REFERENCES
1. Carles G, Tobal N, Raynal P, Herault S, Beucher G, Marret H, et al.
Doppler assessment of the fetal cerebral hemodynamic response to moderate or
severe maternal anemia. Am J Obstet Gynecol 2003;188:794–9.
2. Sifakis S, Pharmakides G. Anemia in pregnancy. Ann N Y Acad Sci
2000;900:125–36.
3.ACOG Practice Bulletin No. 95: anemia in pregnancy.Obstet Gynecol
2008;112(1):201-7.PMID: 18591330
4. Recommendations to prevent and control iron deficiency in the United
States. Centers for Disease Control and Prevention. MMWR Recomm Rep
1998;47(RR-3):1–29.
5.Brittenham GM.Disorders of iron metabolism: iron deficiency and
overload.In: Hoffman R, Benz EJ Jr, Skikne B, et al, eds. Hematology: Basic
Principles and Practice. 4th ed. New York, NY: Churchill Livingstone;
2004:481-487.
6.Campbell NR et al. Ferrous sulfate reduces methyldopa absorption:
methyldopa: iron complex formation as a likely mechanism.
Clin Invest Med. 1990 Dec;13(6):329-32.PMID: 2078911
7. Alteration of methyldopa absorption, metabolism, and blood pressure
control caused by ferrous sulfate and ferrous gluconate.Clin Pharmacol Ther. 1988 Apr;43(4):381-6.PMID: 3356082
8. Gordeuk VR et al., High-dose carbonyl iron for iron deficiency anemia: a
randomized double-blind trial.Am J Clin Nutr. 1987 Dec;46(6):1029-34.
PMID: 3318377
9. Devasthali SD et al., Bioavailability of carbonyl iron: a randomized,
double-blind study.Eur J Haematol. 1991 May;46(5):272-8.PMID: 2044721
10.Gordeuk VR, Brittenham GM, McLaren CE, Hughes MA, Keating LJ. Carbonyl
iron therapy for iron deficiency anemia. Blood 1986 Mar;67(3):745-752.
11. Brittenham GM, Klein HG, Kushner JP, Ajioka RS. Preserving the national
blood supply. Hematology Am Soc Hematol Educ Program. 2001:422-32.
12. Hamstra RD, Block MH, Schocket AL. Intravenous iron dextran in clinical
medicine. JAMA 1980;243:1726–31.
13. Hallak M, et al. Supplementing iron intravenously in pregnancy. A way to
avoid blood transfusions.J Reprod Med. 1997 Feb;42(2):99-103. PMID: 9058345
14. Pemmaraju N. An Absorbing Problem Am J Med. 2007 Mar;120(3):229-30.
PMID: 17349442
15 Ransford R.A. J., Hayes M., Palmer M., Hall M.J.: J Clin
Gastroenterol 35. (3): 228-233.2002
16. Bayoumeu F, Subiran-Buisset C, Baka NE, Legagneur H, Monnier- Barbarino
P, Laxenaire MC. Iron therapy in iron deficiency anemia in pregnancy:
intravenous route versus oral route. Am J Obstet Gynecol. 2002
Mar;186(3):518-22. PMID: 11904617
17. RA Al , et al., Intravenous versus oral iron for treatment of anemia in pregnancy: a randomized trial.Obstet Gynecol. 2005 ;106(6):1335-40. PMID: 16319260
18. Venofer® (Iron Sucrose Injection, USP) package insert. American Regent, Inc. Shirley, NY, 11967
2014
http://www.americanregent.com/documents/Product53PrescribingInformation.pdf
19. Pavord S et. al., UK guidelines on the management of iron deficiency in
pregnancy
British Committee for Standards in Haematology.July 2011
http://www.bcshguidelines.com/documents/UK_Guidelines_iron_deficiency_in_pregnancy.pdf
20. Pharmacy Retailing (NZ) Limited Venofer datasheet 10 February 2014
http://www.medsafe.govt.nz/profs/datasheet/v/venoferinf.pdf (accessed
10/20/2015)
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