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# Ferrous Ascorbate
## Overview
Ferrous ascorbate is a combination product containing elemental iron and ascorbic acid. Ascorbic acid enhances iron absorption.
## Primary Indications
Treatment of iron deficiency anemia.
## Adult Dosing
* **Iron Deficiency Anemia:** 100 mg to 200 mg of elemental iron daily, divided once or twice daily. Maximum daily elemental iron dose is typically 200 mg. Specific dosing may vary based on severity and patient tolerance.
## Pediatric Dosing
Dosing for pediatric patients should be based on elemental iron, calculated by weight.
* **Prevention:** 1 mg/kg/day elemental iron, not to exceed 30 mg/day.
* **Treatment:** 3 mg/kg/day to 6 mg/kg/day elemental iron, divided in 2-3 doses, not to exceed 200 mg/day.
Specific pediatric dosing may vary based on local guidelines and product availability.
## Dose Adjustments
No specific dose adjustments are commonly required for renal or hepatic impairment, but caution is advised due to potential for accumulation and gastrointestinal side effects.
## Contraindications
* Hypersensitivity to iron or ascorbic acid.
* Conditions with iron overload (e.g., hemochromatosis, hemosiderosis).
* Anemia not due to iron deficiency (e.g., megaloblastic anemia due to B12 or folate deficiency).
## Adverse Effects
Common: Gastrointestinal upset (nausea, vomiting, constipation, diarrhea, abdominal pain), metallic taste, dark stools.
Less Common: Allergic reactions, epigastric distress.
## Key Drug Interactions
* **Tetracyclines and Doxycycline:** Decreased absorption of both. Separate administration by at least 2-4 hours.
* **Ciprofloxacin and Levofloxacin:** Decreased absorption of fluoroquinolones. Separate administration by at least 2-4 hours.
* **Antacids (calcium carbonate, magnesium hydroxide):** Decreased iron absorption. Separate administration by at least 2 hours.
* **Levothyroxine:** Decreased absorption of levothyroxine. Separate administration by at least 4 hours.
* **Penicillamine:** Decreased absorption of penicillamine. Separate administration by at least 2 hours.
## Monitoring
* Hemoglobin and hematocrit to assess response.
* Iron studies (serum iron, TIBC, transferrin saturation, ferritin) may be useful for assessing iron stores and monitoring treatment effectiveness, particularly in patients with prolonged treatment.
* Assess for signs and symptoms of gastrointestinal intolerance.
## Clinical Pearls
* Administer ferrous ascorbate on an empty stomach for optimal absorption, but if gastrointestinal upset occurs, taking with a small amount of food that does not contain dairy or high fiber may be necessary.
* Avoid taking with milk, antacids, tea, or coffee as these can significantly impair iron absorption.
* Ascorbic acid in the formulation enhances iron absorption.
* Dark stools are a common and expected side effect.
* Iron overdose is a medical emergency; keep out of reach of children.
***
*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions.*
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