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# Ferrous Ascorbate ## Overview Ferrous ascorbate is an oral iron supplement that combines ferrous iron with ascorbic acid. Ascorbic acid enhances iron absorption. ## Primary Indications Treatment and prevention of iron deficiency anemia. ## Adult Dosing * **Treatment of iron deficiency anemia:** Typically 60-120 mg of elemental iron per day, divided into 1-2 doses. Some protocols may recommend up to 180-240 mg of elemental iron per day in severe cases, divided into 3-4 doses. * **Prevention of iron deficiency anemia:** Typically 30-60 mg of elemental iron per day. **Note:** The following formulations are common: * Tablets/Capsules: Often contain 100 mg ferrous sulfate (equivalent to 20 mg elemental iron) and 300 mg ascorbic acid. * Syrup/Liquid: Dose is based on elemental iron content. ## Pediatric Dosing Dosing is based on elemental iron and varies by age and indication. Consult pediatric guidelines or a specialist for specific recommendations. Typical ranges: * **Prevention:** 1 mg/kg elemental iron per day, not to exceed 15 mg/day. * **Treatment:** 3-6 mg/kg elemental iron per day, divided into 2-3 doses, not to exceed 60 mg elemental iron per day. ## Dose Adjustments No specific dose adjustments are typically required for hepatic or renal impairment. However, iron should be used with caution in these populations due to potential for accumulation and side effects. ## Contraindications * Hemochromatosis and other iron overload conditions. * Hypersensitivity to ferrous ascorbate or its components. * Patients receiving repeated blood transfusions. ## Adverse Effects Common adverse effects include gastrointestinal upset (nausea, vomiting, constipation, diarrhea, abdominal pain, dark stools). Less common: metallic taste, staining of teeth (liquid formulations). ## Key Drug Interactions * **Antacids, calcium supplements, tetracyclines, fluoroquinolones, levothyroxine:** Decreased absorption of both iron and the interacting drug. Separate administration by at least 2-4 hours. * **Proton pump inhibitors (PPIs):** May decrease iron absorption. * **Vitamin E:** May interfere with iron absorption. * **Chloramphenicol:** May blunt the hematopoietic response to iron therapy. ## Monitoring * Hemoglobin, hematocrit, transferrin saturation, ferritin. * Response to therapy (e.g., improvement in symptoms of anemia). * Monitor for gastrointestinal side effects. ## Clinical Pearls * Administer on an empty stomach for maximal absorption, but if gastrointestinal upset occurs, take with food. * Avoid taking with milk, dairy products, antacids, or tea, as these can impair absorption. * Ascorbic acid increases the absorption of non-heme iron. * Dark stools are an expected and harmless side effect. * Iron overload can be serious; ensure correct dosing and discontinue if signs of overload occur. *** **Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always verify current prescribing information with the drug's official labeling and consult with a healthcare provider before making any treatment decisions.