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# Ferrous Ascorbate
## Overview
Ferrous ascorbate is a combination product containing elemental iron and ascorbic acid. Ascorbic acid enhances the absorption of non-heme iron.
## Primary Indications
Treatment and prevention of iron deficiency anemia.
## Adult Dosing
Dosing is typically based on elemental iron content.
* **Treatment of iron deficiency anemia:** 100-200 mg elemental iron per day, divided into 1-2 doses. For example, a 100 mg ferrous ascorbate tablet often contains 100 mg elemental iron.
* **Prevention of iron deficiency:** 30-60 mg elemental iron per day.
The exact daily dose and duration of therapy depend on the severity of iron deficiency and patient response.
## Pediatric Dosing
Dosing is typically based on elemental iron content and age.
* **Treatment of iron deficiency anemia:** 3-6 mg/kg/day of elemental iron, divided into 1-3 doses. Maximum dose is generally 200 mg elemental iron per day.
* **Prevention of iron deficiency:** 1-2 mg/kg/day of elemental iron, up to a maximum of 60 mg elemental iron per day.
Specific pediatric dosing may vary based on age and product formulation; consult product-specific labeling or local protocols.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised, especially in patients with severe impairment. Monitor for signs of iron overload.
## Contraindications
* Hemochromatosis or other iron overload conditions.
* Hypersensitivity to iron or ascorbic acid.
* Untreated vitamin B12 deficiency (megaloblastic anemia).
* Gastrointestinal conditions that may be exacerbated by iron (e.g., active peptic ulcer disease, regional enteritis, ulcerative colitis).
## Adverse Effects
Common adverse effects include gastrointestinal upset (nausea, vomiting, constipation, diarrhea, abdominal pain, metallic taste), dark stools, and staining of teeth. Less common but serious adverse effects include iron overload, allergic reactions.
## Key Drug Interactions
* **Antibiotics (tetracyclines, fluoroquinolones):** Iron can reduce absorption. Separate administration by at least 2 hours.
* **Levothyroxine:** Iron can reduce absorption. Separate administration by at least 4 hours.
* **Proton Pump Inhibitors (PPIs) and H2 Receptor Antagonists:** May decrease gastric acidity, potentially reducing iron absorption.
* **Antacids:** May interfere with iron absorption.
* **Calcium supplements:** May reduce iron absorption. Separate administration.
## Monitoring
* Hemoglobin, hematocrit, and iron indices (serum ferritin, transferrin saturation) to assess efficacy and resolution of anemia.
* Signs and symptoms of iron deficiency and iron overload.
* Gastrointestinal tolerance.
## Clinical Pearls
* Administer on an empty stomach for optimal absorption, but if gastrointestinal upset occurs, take with food.
* Avoid taking with dairy products, antacids, or other medications that can impair iron absorption.
* Ascorbic acid aids in iron absorption; however, high doses of ascorbic acid can have other effects.
* Stool discoloration (dark or black) is expected and not typically a cause for concern.
* Accidental overdose of iron-containing products is a leading cause of poisoning deaths in children under 6 years; keep out of reach of children.
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***Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions.*
