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# Ferrous ascorbate
## Overview
Ferrous ascorbate is a salt of ferrous iron and ascorbic acid, used for the treatment of iron deficiency anemia. Ascorbic acid enhances iron absorption.
## Primary Indications
Iron deficiency anemia.
## Adult Dosing
Dosing is highly variable and depends on the degree of iron deficiency. Typical elemental iron recommendations range from 50-100 mg elemental iron per day, divided into 1-3 doses.
* **Treatment of iron deficiency anemia:** Typically 100-200 mg of elemental iron per day, divided.
## Pediatric Dosing
Dosing is based on elemental iron and varies by age and severity of deficiency. Consult specific pediatric guidelines.
* **Infants and Children (under 12 years):** Dosing typically ranges from 3-6 mg/kg/day of elemental iron, divided into 1-3 doses. Maximum elemental iron dose generally 100 mg/day.
* **Children (12 years and older):** As per adult recommendations.
## Dose Adjustments
* **Renal Impairment:** No specific dose adjustment is typically required for ferrous ascorbate itself, but underlying renal disease might impact the severity of anemia or iron needs.
* **Hepatic Impairment:** No specific dose adjustment is typically required for ferrous ascorbate.
## Contraindications
* Hypersensitivity to ferrous ascorbate or any component of the formulation.
* Patients with hemochromatosis or other causes of iron overload.
* Thalassemia major.
* Recurrent transfusions.
## Adverse Effects
Common adverse effects include gastrointestinal upset (nausea, vomiting, constipation, diarrhea, abdominal pain, dark stools), metallic taste. Less common: gastric irritation, heartburn.
## Key Drug Interactions
* **Antibiotics (Tetracyclines, Quinolones):** Decreased absorption of both agents. Separate administration by at least 2 hours.
* **Bisphosphonates:** Decreased absorption of bisphosphonates. Separate administration by at least 2 hours.
* **Levothyroxine:** Decreased absorption of levothyroxine. Separate administration by at least 4 hours.
* **Proton Pump Inhibitors (PPIs) & H2 Blockers:** May decrease gastric acidity, potentially reducing iron absorption.
* **Antacids:** May interfere with iron absorption.
* **Vitamin E:** May interfere with iron absorption.
## Monitoring
* Hemoglobin and hematocrit.
* Reticulocyte count.
* Serum ferritin and transferrin saturation.
* Resolution of symptoms of anemia.
## Clinical Pearls
* Administer on an empty stomach for optimal absorption, but if GI upset occurs, take with a small amount of food. Avoid taking with milk, antacids, or other medications that interfere with absorption.
* Ascorbic acid enhances iron absorption; however, excessive doses of ascorbic acid can lead to paradoxical iron deficiency.
* Stool will become dark or black; this is expected and not indicative of gastrointestinal bleeding.
* Liquid formulations can stain teeth; it is recommended to dilute the dose in water or juice and rinse the mouth afterward, or use a straw.
* Dosing of elemental iron can vary between different ferrous ascorbate products; always confirm the elemental iron content.
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*Disclaimer: This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for complete and up-to-date information before making any clinical decisions. Dosing may vary based on individual patient factors and local protocols.*
