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# Ferrous Ascorbate
## Overview
Ferrous ascorbate is a combination of ferrous iron and ascorbic acid. Ascorbic acid enhances the absorption of non-heme iron.
## Primary Indications
Treatment of iron deficiency anemia.
## Adult Dosing
* **Iron Deficiency Anemia:** Typically 100 mg elemental iron daily in divided doses. The dose is often titrated based on response and tolerance. Some protocols may recommend up to 200 mg elemental iron daily.
* **Elemental Iron Content:** Products vary in ferrous ascorbate content; doses are based on elemental iron. For example, a 60 mg elemental iron tablet would contain approximately 180 mg of ferrous ascorbate.
## Pediatric Dosing
Dosing varies by age and severity of iron deficiency. Consult specific pediatric guidelines or protocols. General recommendations for iron supplementation in infants and children can range from 3-6 mg/kg/day of elemental iron, divided into 1-3 doses. Maximum pediatric dose is generally not to exceed adult recommendations.
## Dose Adjustments
No dose adjustments are typically required for hepatic or renal impairment, but caution is advised.
## Contraindications
* Hemochromatosis
* Hemosiderosis
* Other causes of iron overload
* Hypersensitivity to ferrous ascorbate or its components
## Adverse Effects
Common: Gastrointestinal upset (nausea, vomiting, constipation, diarrhea, abdominal pain), dark stools.
Less Common: Metallic taste, allergic reactions.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Iron reduces the absorption of these antibiotics. Separate administration by at least 2 hours (before or after).
* **Levothyroxine:** Iron reduces the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids and Calcium Supplements:** May reduce iron absorption. Separate administration by at least 2 hours.
* **Proton Pump Inhibitors (PPIs):** May decrease gastric acidity, potentially reducing iron absorption. Concurrent use should be evaluated.
## Monitoring
* Hemoglobin, hematocrit, and red blood cell indices.
* Ferritin levels (to assess iron stores).
* Signs and symptoms of iron deficiency anemia.
* Gastrointestinal tolerance.
## Clinical Pearls
* Administer ferrous ascorbate on an empty stomach to maximize absorption, if tolerated. If gastrointestinal upset occurs, it can be taken with a small amount of food.
* Avoid taking with milk, antacids, or calcium supplements.
* Ascorbic acid (Vitamin C) can be taken with ferrous ascorbate to further enhance iron absorption.
* Educate patients about potential side effects, especially constipation and dark stools.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information, institutional protocols, and patient-specific factors before making any clinical decisions.
