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# Ferrous Ascorbate
## Overview
Ferrous ascorbate is a chelated form of iron consisting of ferrous iron and ascorbic acid. The inclusion of ascorbic acid acts as a reducing agent, maintaining iron in the ferrous (Fe2+) state, which enhances solubility and intestinal absorption compared to standard ferrous sulfate.
## Primary Indications
Treatment and prevention of iron deficiency anemia.
## Adult Dosing
* **Typical dose:** 100 mg (elemental iron) orally once or twice daily.
* **Maximum:** Dosing above 200 mg elemental iron daily is rarely required and increases risk of gastrointestinal toxicity.
* **Note:** Dosing varies based on severity of anemia and hemoglobin recovery targets; follow institutional hematology protocols.
## Pediatric Dosing
* **Treatment:** 3–6 mg/kg/day of elemental iron, typically divided into 1–3 doses.
* **Prophylaxis:** 1–2 mg/kg/day of elemental iron.
* **Note:** Consult specialized pediatric resources (e.g., Harriet Lane Handbook) for age-specific weight-based adjustments. Do not exceed adult maximums.
## Dose Adjustments
* **Renal Impairment:** No specific adjustment required; however, monitor closely in patients with chronic kidney disease (CKD) who may require parenteral iron if oral absorption is poor (e.g., elevated hepcidin states).
* **Hepatic Impairment:** No standard adjustment required.
## Contraindications
* Known hypersensitivity to iron or ascorbic acid.
* Hemochromatosis and hemosiderosis (iron overload states).
* Hemolytic anemia (unless iron deficiency is also present).
* Repeated blood transfusions.
## Adverse Effects
* **Common:** Gastrointestinal upset (epigastric pain, nausea, constipation, or diarrhea), dark-colored stools.
* **Serious:** Acute iron toxicity (rare with oral dosing, higher risk in children), potential for iron overload long-term.
## Key Drug Interactions
* **Absorption Inhibition:** Antacids, calcium supplements/dairy, proton pump inhibitors, and H2-receptor antagonists significantly decrease absorption. Take iron 2 hours before or 4 hours after these agents.
* **Decreased Absorption of Others:** Decreases the absorption of levodopa, methyldopa, penicillamine, bisphosphonates, and fluoroquinolone/tetracycline antibiotics. Separate doses by at least 2–4 hours.
## Monitoring
* **Efficacy:** Hemoglobin and hematocrit levels (usually monitored 2–4 weeks after initiation).
* **Iron Stores:** Serum ferritin and transferrin saturation (TSAT) to assess replenishment of stores.
* **Toxicity:** Monitor for signs of severe GI distress or iron indices if patient has history of chronic iron overload.
## Clinical Pearls
* **Bioavailability:** Food, especially dairy and coffee/tea, can inhibit absorption. Administration on an empty stomach is preferred; if GI intolerance occurs, it may be taken with food, accepting a slight decrease in absorption.
* **Dark Stools:** Inform patients that stools will turn black or dark green; this is harmless and expected.
* **Liquid Formulations:** May stain teeth; use a straw or rinse mouth after administration.
* **Compliance:** Compliance is often limited by GI side effects. If intolerable, consider alternate-day dosing, which has shown efficacy with potentially fewer GI side effects in some studies.
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**Educational Disclaimer:** This information is for educational purposes for healthcare professionals. Clinical practice varies by region and institution. Always verify specific dosing, safety, and contraindications by consulting current FDA-approved prescribing information, local clinical guidelines, or a clinical pharmacist before prescribing or administering.
