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# Ferrous Ascorbate
## Overview
Ferrous ascorbate is a combined salt of ferrous iron and ascorbic acid, used to treat iron deficiency anemia. Ascorbic acid enhances the absorption of non-heme iron. Available in various formulations, including oral tablets and solutions.
## Primary Indications
* Treatment of iron deficiency anemia.
* Prevention of iron deficiency in individuals with increased needs (e.g., pregnancy, chronic blood loss).
## Adult Dosing
* **Treatment of Iron Deficiency Anemia:** Typically 100-200 mg of elemental iron per day, divided into 2-3 doses.
* Example: Ferrous ascorbate 60 mg elemental iron (equivalent to 250 mg ferrous ascorbate tablet) orally twice daily.
* **Prevention:** Typically 30-60 mg of elemental iron per day. Dosing may vary based on individual risk factors and local protocols.
## Pediatric Dosing
* **Treatment of Iron Deficiency Anemia:**
* Infants and Children: 3-6 mg of elemental iron per kg per day, divided into 1-3 doses. Maximum dose: 60 mg elemental iron per day.
* Example: Ferrous ascorbate 10 mg elemental iron (equivalent to ~25 mg ferrous ascorbate liquid) orally twice daily for a 10 kg child.
* **Prevention:** 1 mg of elemental iron per kg per day. Maximum dose: 15 mg elemental iron per day.
* Dosing for children is highly dependent on age, weight, and severity of deficiency. Consult specific pediatric guidelines or local protocols.
## Dose Adjustments
* **Renal Impairment:** No specific dose adjustment is typically recommended due to minimal renal excretion of iron. However, caution is advised.
* **Hepatic Impairment:** Use with caution.
## Contraindications
* Established iron overload (e.g., hemochromatosis).
* Hypersensitivity to ferrous ascorbate or any component of the formulation.
* Patients receiving repeated blood transfusions.
* Untreated megaloblastic anemia due to vitamin B12 deficiency.
## Adverse Effects
* **Common:** Gastrointestinal disturbances including constipation, diarrhea, nausea, vomiting, abdominal pain, dark stools.
* **Serious:** Iron overload, anaphylaxis (rare).
## Key Drug Interactions
* **Antacids, Calcium Supplements, Tetracyclines, Doxycycline, Quinolones:** May decrease iron absorption. Separate administration by at least 2 hours.
* **Levothyroxine:** May decrease absorption of levothyroxine. Separate administration by at least 4 hours.
* **Penicillamine:** May decrease absorption of penicillamine. Separate administration.
* **Proton Pump Inhibitors (PPIs):** May decrease absorption of iron. Separate administration.
* **Ascorbic acid (high doses):** May increase risk of oxalate stone formation in susceptible individuals.
## Monitoring
* Hemoglobin, hematocrit, and reticulocyte count to assess response to therapy.
* Iron studies (serum iron, TIBC, ferritin) may be monitored to confirm deficiency and assess iron stores.
* Monitor for signs and symptoms of gastrointestinal intolerance.
## Clinical Pearls
* Administer on an empty stomach for optimal absorption. If gastrointestinal upset occurs, taking with a small amount of food (avoiding dairy, eggs, whole-grain cereals) may be necessary.
* Taking ferrous ascorbate with citrus juice (rich in vitamin C) can enhance absorption.
* Stool will likely turn dark or black; this is expected and harmless.
* Accidental overdose can be particularly dangerous in children; keep out of reach of children. Iron overdose is a medical emergency.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.
