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# Ferrous Ascorbate
## Overview
Ferrous ascorbate is an iron salt of ascorbic acid (vitamin C). The addition of ascorbic acid enhances the absorption of elemental iron by creating an acidic environment in the gut and reducing ferric iron to the more readily absorbed ferrous state.
## Primary Indications
* Treatment and prophylaxis of iron deficiency anemia.
* Iron deficiency states where oral iron supplementation is required.
## Adult Dosing
* **Treatment of Iron Deficiency Anemia:** 100 mg (elemental iron) once or twice daily.
* **Maximum Dose:** Typically up to 200–300 mg elemental iron per day, split into multiple doses, though once-daily dosing is increasingly preferred to minimize gastrointestinal side effects and manage hepcidin response.
## Pediatric Dosing
* **Treatment:** 3–6 mg elemental iron/kg/day, divided into 1–3 doses.
* *Note:* Weight-based dosing should be confirmed against local pediatric protocols and the specific formulation available. Do not exceed adult maximums.
## Dose Adjustments
* **Renal Impairment:** Reduce frequency in severe cases; iron is not renally cleared, but patients with chronic kidney disease may have altered iron requirements.
* **Hepatic Impairment:** No specific adjustment; use with caution in patients with hepatic iron overload (e.g., hemochromatosis).
## Contraindications
* Hypersensitivity to iron or ascorbic acid.
* Hemochromatosis, hemosiderosis, or any condition involving iron overload.
* Hemolytic anemia (unless iron deficiency is also present).
* Repeated blood transfusions.
## Adverse Effects
* **Gastrointestinal:** Nausea, epigastric pain, constipation, diarrhea, and dark/black stools (expected and benign).
* **Systemic:** Potential for iron overload with chronic, excessive use.
## Key Drug Interactions
* **Antacids/H2-blockers/PPIs:** Decrease iron absorption; separate doses by at least 2 hours.
* **Fluoroquinolones/Tetracyclines:** Iron chelates with these antibiotics, significantly reducing their absorption; administer iron 2 hours before or 4–6 hours after these medications.
* **Levodopa/Methyldopa:** Iron may reduce the absorption/efficacy of these agents.
## Monitoring
* **Hemoglobin/Hematocrit:** 2–4 weeks after initiation to assess response.
* **Ferritin/Transferrin Saturation:** To monitor long-term iron stores after anemia resolves.
* **Stool:** Monitor for occult blood if GI tract pathology is suspected, as dark stools may obscure interpretation.
## Clinical Pearls
* **Absorption Enhancement:** While ascorbic acid already aids absorption, taking with a glass of water on an empty stomach (1 hour before or 2 hours after meals) yields maximum absorption; however, food can be used to mitigate GI intolerance.
* **Toxicity:** Iron is highly toxic in overdose. Keep out of reach of children. Suspect toxicity if the patient presents with severe abdominal pain, vomiting, or hematemesis.
* **Adherence:** GI side effects are the most common reason for discontinuation. If bothersome, consider dose reduction or alternative-day dosing before total cessation.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines and local protocols vary. Always verify current prescribing information, contraindications, and dosing with pharmacy references (e.g., Lexicomp, Micromedex) or institutional guidelines before prescribing or administering medication.
