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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), which enhances iron absorption.
## Primary Indications
* Treatment of iron deficiency anemia.
* Prevention of iron deficiency anemia in individuals at risk.
## Adult Dosing
* **Treatment of iron deficiency anemia:** Typically 100-200 mg of elemental iron daily, divided into 1-2 doses.
* **Prevention of iron deficiency anemia:** Typically 30-60 mg of elemental iron daily.
* Dosing may vary based on the severity of anemia and individual tolerance. Specific dosing regimens are often guided by local protocols.
## Pediatric Dosing
* **Treatment of iron deficiency anemia:**
* Infants and children: 3-6 mg/kg/day of elemental iron, divided into 2-3 doses. Maximum dose is typically 100-200 mg elemental iron per day.
* Adolescents: Similar to adult dosing, adjusted for weight if necessary.
* **Prevention of iron deficiency anemia:**
* Infants and children: 1 mg/kg/day of elemental iron, up to a maximum of 15 mg elemental iron per day.
* Specific dosing depends on age, weight, and the presence and severity of iron deficiency.
## Dose Adjustments
* No specific dose adjustments are routinely required for hepatic or renal impairment, but caution and close monitoring are advised due to potential for iron accumulation.
## Contraindications
* Hypersensitivity to ferrous ascorbate or any component of the formulation.
* Hemochromatosis and other causes of iron overload.
* Patients receiving repeated blood transfusions.
* Anemia not due to iron deficiency (e.g., vitamin B12 deficiency, folate deficiency, hemolytic anemia).
## Adverse Effects
* **Common:** Gastrointestinal upset (nausea, vomiting, constipation, diarrhea, abdominal pain, dark stools).
* **Less common:** Metallic taste, staining of teeth (may be reduced by dilution or administration through a straw).
* **Serious (rare, especially with overdose):** Iron toxicity, particularly in children, can lead to severe GI symptoms, metabolic acidosis, shock, and liver damage.
## Key Drug Interactions
* **Absorption reduced by:** Antacids, calcium supplements, tetracyclines, doxycycline, bisphosphonates, levothyroxine, penicillamine, proton pump inhibitors, H2 blockers, cholestyramine, cimetidine, pancreatic enzyme supplements, high fiber foods. Administer ferrous ascorbate at least 2 hours before or 2-4 hours after these agents.
* **Absorption enhanced by:** Ascorbic acid (inherent in ferrous ascorbate), vitamin C.
* **Iron may decrease absorption of:** Tetracyclines, doxycycline, fluoroquinolones.
* **Iron may decrease absorption of:** Mycophenolate mofetil. Separate administration by at least 4-6 hours.
* **Iron may increase absorption of:** Methyldopa.
## Monitoring
* Hemoglobin, hematocrit, and ferritin levels to assess response to therapy and iron stores.
* Monitor for signs and symptoms of iron toxicity, especially in children.
* Periodic assessment of gastrointestinal tolerance.
## Clinical Pearls
* Administer ferrous ascorbate on an empty stomach to maximize absorption, but if GI upset occurs, take with a small amount of food (avoiding high-fiber foods and other interacting substances).
* Ascorbic acid enhances iron absorption; the formulation intrinsically provides this benefit.
* Dark stools are a expected side effect and not indicative of bleeding.
* Keep out of reach of children due to the risk of accidental overdose and iron poisoning.
* Iron supplements are a leading cause of poisoning deaths in young children; store securely.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and product monographs for complete details, including contraindications, warnings, precautions, and potential adverse reactions. Verify dosing and indications with local protocols and institutional guidelines.*
