Ferrous Ascorbate

# Ferrous ascorbate ## Overview - **Classification**: Iron supplement, hematinic. - **Mechanism**: Provides elemental iron essential for hemoglobin synthesis and oxygen transport. The ascorbate component (Vitamin C) enhances ferrous iron absorption. ## Primary Indications 1. **Iron Deficiency Anemia (IDA)**: Treatment of established iron deficiency anemia. 2. **Iron Prophylaxis**: Prevention of iron deficiency in high-risk groups (e.g., pregnancy, chronic blood loss, malabsorption). ## Adult Dosing ### Standard Dosing **Iron Deficiency Anemia (Treatment)** - **Dose**: **100 mg elemental iron** (equivalent to 304.86 mg ferrous ascorbate) - **Frequency**: **Once daily** or **twice daily** - **Route**: Oral - **Duration**: Typically 3-6 months after hemoglobin normalizes to replenish iron stores. **Iron Prophylaxis (e.g., Pregnancy)** - **Dose**: **30-60 mg elemental iron** (equivalent to 91.46-182.92 mg ferrous ascorbate) - **Frequency**: **Once daily** - **Route**: Oral ### Dose Adjustments - **Renal Impairment**: No specific dose adjustment; use caution in severe impairment due to potential iron accumulation. - **Hepatic Impairment**: No specific dose adjustment; caution with severe liver disease. - **Elderly Patients**: Consider starting with a lower dose if GI sensitivity is a concern; monitor for constipation. ## Pediatric Dosing *(Doses are expressed as elemental iron)* ### Neonates (0-28 days) - **Indication**: Prophylaxis for low birth weight infants (if not receiving fortified formula). - **Dose**: **2-4 mg elemental iron/kg/day** - **Frequency**: Once daily, or divided BID if tolerated. - **Maximum**: Individualized based on total iron intake from all sources. - **Special Notes**: Use liquid formulations. Ensure accurate elemental iron content. ### Infants (1-12 months) - **Indication**: Iron Deficiency Anemia (Treatment) - **Dose**: **3-6 mg elemental iron/kg/day** (in 1-3 divided doses) - **Frequency**: Once daily to three times daily - **Maximum**: **15 mg elemental iron/day** for prophylaxis; up to **60 mg elemental iron/day** for treatment. - **Special Notes**: Liquid formulation preferred. Administer with food to reduce GI upset. ### Children (1-12 years) - **Indication**: Iron Deficiency Anemia (Treatment) - **Dose**: **3-6 mg elemental iron/kg/day** (in 1-3 divided doses) - **Frequency**: Once daily to three times daily - **Maximum**: Up to **200 mg elemental iron/day** (or adult equivalent). - **Special Notes**: Liquid, chewable tablets, or regular tablets as appropriate for age. High risk for accidental overdose. ### Adolescents (13-18 years) - **Indication**: Iron Deficiency Anemia (Treatment) - **Dose**: **60-100 mg elemental iron** - **Frequency**: Once daily to twice daily - **Maximum**: Generally follows adult maximums, up to **200 mg elemental iron/day**. ## Safety Information ### Contraindications - **Absolute**: Hemochromatosis or hemosiderosis (iron overload disorders). - **Absolute**: Hemolytic anemia (unless concurrent iron deficiency is confirmed). - **Absolute**: Repeated blood transfusions (risk of iron overload). - **Absolute**: Hypersensitivity to ferrous ascorbate or any component. - **Relative**: Active peptic ulcer disease, regional enteritis, ulcerative colitis (may exacerbate GI irritation). ### Common Adverse Effects - **Very Common (>10%)**: GI upset (nausea, abdominal pain), constipation, diarrhea, dark stools. - **Common (1-10%)**: Heartburn, stomach cramps. - **Serious but Rare**: Iron poisoning (especially in children), severe allergic reactions. ### Key Drug Interactions - **Tetracyclines/Fluoroquinolones**: Decreased absorption of antibiotics. Separate administration by 2-4 hours. - **Antacids/PPIs/H2 blockers**: Decreased iron absorption due to increased gastric pH. Administer iron 2 hours before or 4 hours after. - **Levothyroxine**: Decreased levothyroxine absorption. Separate administration by at least 4 hours. - **Bisphosphonates**: Decreased bisphosphonate absorption. Separate administration by at least 2 hours. ## Monitoring & Follow-up - **Before Treatment**: Baseline Hemoglobin (Hb), Hematocrit (Hct), Ferritin, Serum Iron, Total Iron Binding Capacity (TIBC). - **During Treatment**: Reticulocyte count (after 1 week), Hb/Hct (every 3-4 weeks), Ferritin (after 3 months). - **Clinical Signs**: Monitor for expected dark stools, constipation, and signs of clinical improvement (e.g., increased energy, decreased pallor). ## Clinical Pearls - 💡 **Administration**: Best absorbed on an empty stomach but can be taken with food to minimize GI upset. - 💡 **Absorption Aid**: The ascorbate component already enhances iron absorption; additional Vitamin C is usually not needed. - 💡 **Pediatric Safety**: Iron supplements are a leading cause of accidental poisoning deaths in children. Store securely out of reach. - 💡 **Stool Color**: Inform patients that stools will turn dark or black, which is a normal and harmless effect. - 💡 **Dental Staining**: Liquid iron can stain teeth. Advise mixing with water/juice and administering via straw or dropper to back of mouth, followed by brushing. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.