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# Ferrous Ascorbate
## Overview
Ferrous ascorbate is a salt of ferrous iron and ascorbic acid. Ascorbic acid enhances iron absorption. It is used to treat iron deficiency anemia.
## Primary Indications
* Treatment of iron deficiency anemia.
* Prevention of iron deficiency anemia in individuals with increased iron requirements or inadequate dietary intake.
## Adult Dosing
Dosing is typically based on elemental iron.
* **Treatment of iron deficiency anemia:** 100-200 mg elemental iron daily, divided into 1-2 doses.
* For example, ferrous ascorbate 60 mg elemental iron per tablet: 1-2 tablets by mouth once or twice daily.
* **Prevention:** 30-60 mg elemental iron daily.
## Pediatric Dosing
Dosing is highly variable and depends on age, weight, and degree of deficiency. Consult specific pediatric guidelines or a pediatrician.
* **Treatment of iron deficiency anemia:** Generally, 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.
* **Prevention:** 1 mg/kg/day of elemental iron, up to a maximum of 15-30 mg elemental iron daily.
## Dose Adjustments
* **Renal Impairment:** No specific adjustments are typically required for ferrous ascorbate itself, but patients with severe renal impairment may require closer monitoring for iron overload.
* **Hepatic Impairment:** No specific adjustments are typically required.
## Contraindications
* Established hypersensitivity to ferrous ascorbate or any component.
* Hemochromatosis, hemosiderosis, hemolytic anemia, or other conditions of iron overload.
* Gastrointestinal obstruction or active peptic ulcer disease.
## Adverse Effects
* **Common:** Constipation, diarrhea, nausea, vomiting, abdominal pain, dark stools, metallic taste.
* **Serious:** Iron overload (especially with chronic high-dose use or in susceptible individuals), hypersensitivity reactions.
## Key Drug Interactions
* **Antibiotics (Tetracyclines, Quinolones):** Iron reduces absorption of these antibiotics. Separate administration by at least 2 hours.
* **Levothyroxine:** Iron reduces absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids, Calcium Supplements:** Can decrease iron absorption. Avoid co-administration.
* **Proton Pump Inhibitors:** May decrease iron absorption.
* **Vitamin E:** May interfere with iron absorption.
## Monitoring
* Hemoglobin, hematocrit, and iron studies (serum ferritin, transferrin saturation) to assess therapeutic response and iron status.
* Monitor for signs and symptoms of gastrointestinal upset.
* Monitor for signs of iron overload in patients with risk factors.
## Clinical Pearls
* Take ferrous ascorbate on an empty stomach for optimal absorption, but if gastrointestinal upset occurs, take with food.
* Concurrent administration of vitamin C (ascorbic acid) enhances iron absorption; ferrous ascorbate already contains vitamin C.
* Avoid taking with milk, calcium, antacids, coffee, or tea, as these can significantly impair iron absorption.
* Inform patients that stools may turn black or dark green, which is a normal side effect.
* Iron poisoning is a medical emergency; keep out of reach of children.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for detailed prescribing information or professional medical advice. Always consult the most current product labeling and relevant guidelines before prescribing or dispensing any medication. Clinical decisions should be made based on individual patient factors and current medical evidence.
