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# Ferrous ascorbate
## Overview
Ferrous ascorbate is an iron salt combined with ascorbic acid. Ascorbic acid enhances the absorption of iron.
## Primary Indications
Treatment and prevention of iron deficiency anemia.
## Adult Dosing
The dose of elemental iron varies. Typical doses range from 60-100 mg of elemental iron daily, often divided into two doses. Maximum daily elemental iron is generally not established, but doses exceeding 200 mg elemental iron per day are rarely prescribed and may increase risks. Specific dosing often depends on the severity of anemia and institutional protocols.
## Pediatric Dosing
Dosing is based on elemental iron.
* **Treatment of iron deficiency anemia:** 3-6 mg/kg/day of elemental iron, divided into 2-3 doses. Maximum dose not to exceed 200 mg of elemental iron per day.
* **Prophylaxis:** 1-2 mg/kg/day of elemental iron, up to a maximum of 65 mg/day.
Dosing requires careful calculation and confirmation with pediatric guidelines.
## Dose Adjustments
No dose adjustments are typically needed for hepatic or renal impairment, but caution is advised in severe disease.
## Contraindications
* Iron overload states (e.g., hemochromatosis, hemosiderosis).
* Known hypersensitivity to ferrous ascorbate or its components.
* Pernicious anemia (unless iron therapy is also indicated).
## Adverse Effects
The most common adverse effects are gastrointestinal, including nausea, vomiting, diarrhea, constipation, abdominal pain, and dark stools.
## Key Drug Interactions
* **Antibiotics (Tetracyclines, Quinolones):** Iron can chelate with these antibiotics, reducing their absorption. Separate administration by at least 2 hours.
* **Levothyroxine:** Iron can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids/Proton Pump Inhibitors:** May decrease iron absorption.
* **Vitamin E:** May interfere with iron absorption.
## Monitoring
* Hemoglobin and hematocrit levels.
* Iron studies (serum ferritin, transferrin saturation) to assess iron stores and response to therapy.
* Monitor for signs and symptoms of gastrointestinal intolerance.
## Clinical Pearls
* Administer on an empty stomach for optimal absorption, if tolerated. If gastrointestinal upset occurs, take with food.
* Ascorbic acid enhances iron absorption; taking with vitamin C-rich foods or a small amount of orange juice can be beneficial.
* Avoid concurrent administration with milk, antacids, eggs, or whole-grain bread, as these can impair absorption.
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**Disclaimer:** This information is intended for clinical pharmacists and healthcare providers and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making any clinical decisions. Dosing and safety information can vary, especially based on specific product formulations and patient populations.
