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# Ferrous Ascorbate
## Overview
Ferrous ascorbate is an oral iron supplement used to treat and prevent iron deficiency anemia. It combines ferrous iron with ascorbic acid (vitamin C) to enhance iron absorption.
## Primary Indications
* Treatment of iron deficiency anemia
* Prevention of iron deficiency anemia
## Adult Dosing
* **Treatment of Iron Deficiency Anemia**: Typically 100-200 mg of elemental iron per day, divided into 1-2 doses. Dosing is often guided by the severity of anemia and patient response.
* **Prevention of Iron Deficiency**: Dosing varies but is generally lower, often around 30-60 mg of elemental iron per day.
* Dosage is usually expressed as **elemental iron**. Always confirm the elemental iron content of the specific product being used.
## Pediatric Dosing
Dosing varies significantly by age and weight. Specific protocols and product formulations should be consulted.
* **Infants and Children**: Dosing is frequently calculated based on weight, often ranging from 3-6 mg/kg/day of elemental iron, divided into 1-3 doses. The maximum dose is typically 200 mg of elemental iron per day.
* **Adolescents**: Similar to adult dosing, depending on iron status and needs.
## Dose Adjustments
* **Renal Impairment**: Use with caution, as iron can accumulate. Monitor iron studies closely. Dose adjustments may be necessary.
* **Hepatic Impairment**: Use with caution. Monitor iron studies closely.
## Contraindications
* Established hypersensitivity to iron or ascorbic acid.
* Conditions of iron overload (e.g., hemochromatosis, aplastic anemia, hemolytic anemia).
* Active peptic ulcer disease, regional enteritis, or ulcerative colitis (oral iron can exacerbate gastrointestinal symptoms).
## Adverse Effects
Common adverse effects include:
* Gastrointestinal upset (nausea, vomiting, constipation, diarrhea, abdominal pain, metallic taste).
* Staining of teeth (can be mitigated by diluting in juice and drinking through a straw, or by brushing teeth after administration).
* Darkening of stool (expected and benign).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones**: Iron reduces absorption; separate administration by at least 2 hours (before or after).
* **Levothyroxine**: Iron reduces absorption; separate administration by at least 4 hours.
* **Proton Pump Inhibitors (PPIs)**: May reduce iron absorption.
* **Antacids**: May reduce iron absorption. Separate administration by at least 2 hours.
* **Ascorbic Acid**: Can enhance the absorption of other medications such as aluminum, iron, and zinc.
## Monitoring
* **Hemoglobin and Hematocrit**: To assess response to therapy.
* **Ferritin**: To assess iron stores.
* **Reticulocyte count**: To evaluate bone marrow response.
* **Stool guaiac**: To rule out gastrointestinal bleeding if clinically suspected.
## Clinical Pearls
* Administer on an empty stomach to maximize absorption, but if gastrointestinal intolerance occurs, food may be taken with the medication. Avoid taking with dairy products, tea, coffee, or high-fiber foods, which can hinder absorption.
* Ascorbic acid (vitamin C) in ferrous ascorbate enhances iron absorption, making it generally better tolerated and more effective than ferrous sulfate for some individuals.
* Iron supplements can be toxic in overdose, especially in children. Keep out of reach of children.
* Educate patients on expected stool color change.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information, local protocols, and patient-specific factors before making any treatment decisions.*
