Oral iron

Iron dextran is a parenteral iron that is also used for die treatment of iron deficiency anemia It is primarily used when the patient cannot take oral drugs or when the patient experiences gastrointestinal intolerance to oral iron administration. Other iron preparations, both oral and parenteral, used in the treatment of iron deficiency anemia can be found in the Summary Drug Table Dragp Used in the Treatment of Anemia... 

The absorption of oral iron is decreased when tlie agent is administered with antacids, tetracyclines, penicillamine, and the fluoroquinolones. When iron is administered with levothyroxine, there may be a decrease in tlie effectiveness of levothyroxine When administered orally, iron deceases the absoqition of lev-odopa. Ascorbic acid increases tlie absoqition of oral iron. Iron dextran administered concurrently with chloramphenicol increases serum iron levels. 

Oral iron solutions may cause temporary staining of the teeth. The solution is diluted with 2 to 4 oz of water or juice and drunk through a straw. The stool may appear darker or black this is a normal occurrence and not a reason for concern. 

MANAGING CONSTIPATION. Constipation may be a problem when a patient is taking oral iron preparations. The nurse instructs the patient to increase fluid intake to 10 to 12 glasses of water per day (if the condition permits), eat a diet high in fiber, and increase activity. An active lifestyle and regular exercise (if condition permits) help to decrease tiie constipating effects of iron. If... 

Which of the following substances would decrease the absorption of oral iron ... 

The following drugp have a decreased pharmacologic effect when administered with an antacid corticosteroids, digoxin, chlorpromazine, oral iron products, isoniazid, phenothiazines, ranitidine, phenytoin, valproic acid, and the tetracyclines. 

Calcium carbonate or magnesium hydroxide antacids may decrease the effectiveness of the digestive enzymes. When administered concurrently with an iron preparation, the digestive enzymes decrease the absorption of oral iron preparations. 

GABRiELLi G B and DE SANDRE G (1995) Excessive tea consumption can inhibit the efficacy of oral iron treatment in iron-deficiency anemia , Haematologica, 80(6), 518-20. 

Oral iron poisoning Cigarette-smoke effects... 

Olivieri, N.F., Koren, G., Hermann, C., Bentur, Y., Chung, D. and Klein, J. (1990). Comparison of oral iron chelator LI and desferrioxamine in iron loaded patients. Lancet 336, 1275-1279. 

The dose of oral iron should be 200 mg elemental iron per day in divided doses. c Initiate erythropoietic therapy as indicated based on Hgb/Hct (see Figure 23-3). 

Iron Supplementation Use of ESAs can lead to iron deficiency if iron stores are not adequately maintained. If serum ferritin and TSAT fall below the goal levels, iron supplementation is required. Oral iron supplements are less costly than IV supplements and are generally the first-line treatment for iron supplementation. When administering iron by the oral route, 200 mg of elemental iron should be delivered daily to maintain adequate iron stores. 

Oral iron supplementation is generally not effective in maintaining adequate iron stores in patients receiving ESAs because of poor absorption and an increased need for iron with ESA therapy, making the IV route necessary for iron supplementation. The IV iron products currently available are iron dextran (distributed as INFeD by Watson Pharmaceuticals, Inc., Morristown, NJ, and Dexferrum by American Reagent, Inc.,... 

In patients with iron-deficiency anemia, appropriate oral iron therapy that delivers sufficient elemental iron should be administered before giving parenteral iron. 

The initial treatment of iron-deficiency anemia is oral iron therapy with 200 mg of elemental iron daily for those who are able to tolerate the oral route. In order to attain this amount of elemental iron daily, many different iron products and salt forms are available. Table 63-3 lists the various salt forms of oral iron available, the amount of elemental iron in each product, and the approximate daily dose of the salt to attain 200 mg of elemental iron daily. 

Because the patient is not able to tolerate oral iron therapy (constipation and nausea), changing to intravenous iron therapy is appropriate. 

Although EPO deficiency is the primary cause of CKD anemia, iron deficiency is often present, and it is essential to assess and monitor the CKD patient s iron status (NKF-K/DOQI guidelines). Iron stores in patients with CKD should be maintained so that transferrin saturation (TSAT) is greater than 20% and serum ferritin is greater than 100 ng/mL (100 mcg/L or 225 pmol/L). If iron stores are not maintained appropriately, epoetin or darbepoetin will not be effective, and most CKD patients will require iron supplementation. Oral iron therapy can be used, but it is often ineffective, particularly in CKD patients on dialysis. Therefore, intravenous iron therapy is used extensively in these patients. Details of the pharmacology, pharmacokinetics, adverse effects, interactions, dose, and administration of erythropoietin and iron products have been discussed previously. 

Oral iron nausea, vomiting, abdominal pain, heartburn, constipation, and dark stools... 

Iron-deficiency anemia in chronic PN patients may be due to underlying clinical conditions and the lack of iron supplementation in PN. Parenteral iron therapy becomes necessary in iron-deficient patients who cannot absorb or tolerate oral iron. Parenteral iron should be used with caution owing to infusion-related adverse effects. A test dose of 25 mg of iron dextran should be administered first, and the patient should be monitored for adverse effects for at least 60 minutes. Intravenous iron dextran then may be added to lipid-free PN at a daily dose of 100 mg until the total iron dose is given. Iron dextran is not compatible with intravenous lipid emulsions at therapeutic doses and can cause oiling out of the emulsion. Other parenteral iron formulations (e.g., iron sucrose and ferric gluconate) have not been evaluated for compounding in PN and should not be added to PN formulations. 

Nramp2 across microvillus 1997) Belgrade (b) rat unresponsive to oral iron... 

Oral iron therapy with soluble ferrous iron salts, which are not enteric coated and not slow- or sustained-release, is recommended at a daily dosage of200 mg elemental iron in two or three divided doses (Table 33-3). 

Parenteral iron may be required for patients with iron malabsorption, intolerance of oral iron therapy, or noncompliance. Parenteral administra-... 

Peritoneal dialysis Attempt oral iron therapy, 200 mg/day elemental iron. Change to IV if necessary. 

The length of iron therapy depends upon the cause and severity of the iron deficiency. In general, approximately 4 to 6 months of oral iron therapy is required to reverse uncomplicated iron deficiency anemias. Iron therapy should increase hemoglobin levels by 1 g/week. 

The parenteral use of complexes of iron and carbohydrates has resulted in anaphylactic-type reactions. Deaths associated with such administration have been reported therefore, use iron dextran injection only in those patients in whom the indications have been clearly established and laboratory investigations confirm an iron-deficient state not amenable to oral iron therapy. Because fatal anaphylactic reactions have been reported after administration of iron dextran injection, administer the drug only when resuscitation techniques and treatment of anaphylactic and anaphylactoid shock are readily available. 

Drug interactions involving iron sucrose have not been studied. However, like other parenteral iron preparations, iron sucrose may be expected to reduce the absorption of concomitantly administered oral iron preparations. Do not administer concomitantly with oral iron preparations. 

Oral Iron preparations Coadministration of parenteral iron preparations may reduce absorption of oral iron preparations. 

Deravirdine (Rescnptor) [Antiretroviral/NNRTI] Uses HIV Infxn Action Nonnucleoside RT inhibitor Dose 400 mg PO tid Caution [C, ] CDC recommends HIV-infected mothers not to breast-feed (transmission risk) w/ renal/hepatic impair Contra Use w/ drugs dependent on CYP3A for clearance (Table VI-8) Disp Tabs SE Fat redistribution, immune reconstitution synd, HA, fatigue, rash, T transaminases, N/V/D Interactions T Effects W/ fluoxetine T effects OF benzodiazepines, cisapride, clarithromycin, dapsone, ergotamine, indinavir, lovastatin, midazolam, nifedipine, quinidine, ritonavir, simvastatin, terfena-dine, triazolam, warfarin effects W/ antacids, barbiturates, carbamazepine, cimetidine, famotidine, lansoprazole, nizatidine, phenobarbital, phenytoin, ranitidine, rifabutin, rifampin effects OF didanosine EMS Use of benzodiazepines and CCBs should be avoided may cause a widespread rash located on upper body and arms OD May cause an extension of nl SEs symptomatic and supportive Deferasirox (Exjade) [Iron Chelator] Uses Chronic iron overload d/t transfusion in pts >2 y Action Oral iron chelator Dose Initial 20 mg/kg... 

Ferrous Gluconate (Fergon) [Oral Iron Supplement]... 

Adverse effects consist mainly of gastrointestinal intolerance such as nausea, epigastric pain and diarrhea and, especially in the elderly constipation with continued therapy. All ferrous salts may cause a black coloration of the faeces. Children are particularly susceptible to potentially lethal iron intoxications. Oral iron preparations should not be administered concurrently with tetracyclines as mutual interference with absorption will occur. 

Efficacy is appreciated clinically and has two distinct components. Initially there is reversal in the impaired effort tolerance that parallels regeneration of the haemoglobin levels. This is followed by a longer period when cognitive function gradually improves after stores are reconstituted. Oral iron typically needs to be given between 3 and 6 months and certainly until both percentage saturation of transferrin and serum, or preferably red cell, ferritin are normal. It is furthermore prudent that treated indi-... 

Alternative options are increasingly favoured in the form of oral iron polymaltose complexes. These are more expensive but attractive in that complications are less frequently encountered and the lethal toxicity that follows release of large amounts or ionic iron into the circulation does not occur. Carbonyl iron is not often used but available in some countries. In contrast combinations with vitamins and cobalt, still popular in certain areas, have no documented advantage and add quite unnecessary cost. Other routes are intramuscular injections and, except where oral administration is precluded, have disadvantages in that mobilization is unpredictable. Conversely, it is feasible to replace iron as a single total dose infusion but such procedures need to be given under supervised conditions. It is reiterated that the rate of rise in haemoglobin that follows adequate oral replacement is comparable to that achieved par-enterally. 

Use only in patients unable to take oral iron and with lab-confirmed iron deficiency. 

Do not take oral iron while receiving iron injections... 

Tetracycline Antacids, dairy products, oral iron, sucralfate, zinc sulphate Reduced absorption. 

After confirmation of iron deficiency iron therapy can be given by oral or parenteral route. Generally oral iron therapy is given unless the patient is suffering from severe anaemia, malabsorption syndrome, gastrectomy or patient is showing adverse effects to oral iron therapy. 

Iron deficiency anemia is treated with oral or parenteral iron preparations. Oral iron corrects the anemia just as rapidly and completely as parenteral iron in most cases if iron absorption from the gastrointestinal tract is normal. An exception is the high requirement for iron of patients with advanced chronic kidney disease who are undergoing hemodialysis and treatment with erythropoietin for these patients, parenteral iron administration is preferred. 

A wide variety of oral iron preparations is available. Because ferrous iron is most efficiently absorbed, only ferrous salts should be used. Ferrous sulfate, ferrous gluconate, and ferrous fumarate are all effective and inexpensive and are recommended for the treatment of most patients. 

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