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# Ferrous Ascorbate
## Overview
Ferrous ascorbate is a combination of ferrous iron and ascorbic acid. Ferrous iron is an essential mineral required for hemoglobin synthesis, and ascorbic acid (Vitamin C) enhances iron absorption.
## Primary Indications
* Treatment of iron deficiency anemia.
## Adult Dosing
* **General Recommendation:** Typically dosed based on elemental iron content. A common regimen is **100-200 mg of elemental iron per day**, divided into 1-2 doses.
* **Elemental Iron Content:** Ferrous ascorbate (e.g., 100 mg tablet) contains approximately 100 mg of ferrous ascorbate, which provides about 19-20 mg of elemental iron. Adjust dosing based on the specific product's elemental iron content.
* **Maximum Dose:** No established maximum daily dose, but treatment should aim to correct anemia effectively while minimizing side effects.
## Pediatric Dosing
* Dosing varies by age and weight and should be guided by pediatric hematology protocols.
* **General Pediatric Recommendation:** Typically around **3-5 mg/kg/day of elemental iron**, divided into 1-3 doses, not to exceed adult doses.
* **Example:** For a child weighing 15 kg, this might be approximately 45-75 mg of elemental iron per day.
## Dose Adjustments
* No specific dose adjustments for renal or hepatic impairment are universally established, but monitor for side effects closely.
## Contraindications
* Hemochromatosis and other causes of iron overload.
* Hypersensitivity to ferrous ascorbate or its components.
* Active peptic ulcer, regional enteritis, or ulcerative colitis due to potential for gastrointestinal irritation.
## Adverse Effects
* **Common:** Nausea, vomiting, constipation, diarrhea, abdominal pain, metallic taste.
* **Serious (rare):** Iron overload, acute iron poisoning (especially in children), hypersensitivity reactions.
## Key Drug Interactions
* **Antacids, Calcium Supplements, Tetracyclines, Doxycycline, Quinolones:** May decrease the absorption of ferrous ascorbate. Separate administration by at least 2 hours.
* **Levothyroxine:** May decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antiretrovirals (e.g., ritonavir):** May decrease absorption of both agents.
* **Ascorbic Acid (high doses):** Can potentially increase risk of kidney stones in susceptible individuals.
## Monitoring
* **Hemoglobin and Hematocrit:** To assess treatment response.
* **Ferritin and Transferrin Saturation:** To evaluate iron stores and diagnose iron deficiency.
* **Signs and Symptoms of Iron Overload:** Especially with long-term or high-dose therapy.
* **Gastrointestinal Tolerance:** Adjust dose or formulation if side effects are problematic.
## Clinical Pearls
* Administer on an empty stomach for optimal absorption, if tolerated. If gastric irritation occurs, take with a small amount of food (avoiding dairy, eggs, and whole grains).
* Taking ferrous ascorbate with citrus juices or Vitamin C supplements can enhance absorption.
* Darkening of stool is a common and expected finding.
* Accidental overdose is a significant concern in children; store securely and out of reach.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols before initiating or modifying treatment.
