Iron supplements 4840621 218408427 2008-06-10T14:52:08Z 150.231.246.1 {{Refimprove|date=March 2007}} '''Iron supplements''' are [[supplements]] that can be prescribed by a doctor for a medical reason. [[Iron]] can also be a [[dietary supplement]], which can be purchased in supermarkets etc. These 2 categories should not be confused. ==Indications== Iron supplements are used in [[medicine]] to treat [[Iron deficiency (medicine)|iron-deficiency]] [[anemia]]. First, it must be clear that iron deficiency and not another factor (e.g. chronic, low-grade, undetected blood loss such as [[fecal occult blood]]) causes the anemia. Preventive measures must be discussed with the patient (for example when the patient is on a [[Vegetarian nutrition#Iron|strict vegetarian diet]] because inorganic iron in plants has a lower [[bioavailability]], or elderly patients with a poor diet). Another indication for giving extra iron is the second and third trimester of [[pregnancy]], generally in association with [[folic acid]]. Indeed, in some condition like growth, menstruation and pregnancy, the body's need for iron is increased. Supplements may be needed to reach [[RDA]] life goals.<ref>[http://dietary-supplements.info.nih.gov/factsheets/iron.asp Dietary Supplement Fact Sheet: Iron] - U.S. [[National Institutes of Health]], Office of Dietary Supplements.</ref> ==Administration== Iron can be supplemented using various pharmacological forms, such as [[iron(II) sulphate or sulfate]] (this is the most common and cheapest [[salt]], e.g. Feratab, Fer-Iron, Slow-FE,…) and in complex with [[gluconate]], [[dextran]], [[carbonyl iron]], and other salts. Sometimes [[ascorbic acid]] is added for better absorption. Generally, iron supplementation therapy is an oral therapy, and [[parenteral]] iron therapy (intravenously or intramuscular) is only given when resorption is seriously compromised (by illnesses, or when the patient cannot swallow) and benefit from oral therapy cannot be expected. It’s more expensive and has increased [[morbidity]]. Since iron stores in the body are generally depleted, and there is a limit to what the body can process (about 100mg per day) without [[iron poisoning]], this is a chronic therapy which may take 3-6 months. In some conditions (e.g. after [[gastrectomy]]), in which there is production of [[intrinsic factor]] by the [[parietal cells]] of the [[stomach]] is complicated), even permanent iron substitution is necessary. Patients at risk of acute complications may be candidates for [[Blood transfusion|transfusion]]. Patients with [[anemia of chronic disease]] may benefit from [[erythropoietin]]. ==Side effects== Side effects of therapy with iron are most often [[diarrhea]] or [[constipation]] and [[epigastric]] abdominal discomfort. Taken after a meal, side effects decrease but there is an increased risk of interaction with other substances. Side effects are [[dose-dependent]], and the dose may be adjusted. The patient may notice that his/her stools become black. This is completely harmless, but patients must be warned about this to avoid unnecessary concern. When iron supplements are given in a liquid form, teeth may reversibly discolor (this can be avoided through the use of a straw). Intramuscular injection can be painful, and brown discoloration may be noticed. When [[haematopoiesis]] resumes, other essentials for this process (such as [[folic acid]] or [[vitamin B12]]) may be depleted, and care must be taken to avoid deficiencies of these elements. Treatments with [[iron(II) sulfate]] have higher incidence of adverse events than iron(III)-hydroxide polymaltose complex (IPC)<ref name="pmid17691594">{{cite journal |author=Geisser P |title=Safety and efficacy of iron(III)-hydroxide polymaltose complex / a review of over 25 years experience |journal=Arzneimittelforschung |volume=57 |issue=6A |pages=439–52 |year=2007 |pmid=17691594 |doi=}}</ref><ref name="pmid17691593">{{cite journal |author=Toblli JE, Brignoli R |title=Iron(III)-hydroxide polymaltose complex in iron deficiency anemia / review and meta-analysis |journal=Arzneimittelforschung |volume=57 |issue=6A |pages=431–8 |year=2007 |pmid=17691593 |doi=}}</ref><ref name="pmid17435611">{{cite journal |author=Saha L, Pandhi P, Gopalan S, Malhotra S, Saha PK |title=Comparison of efficacy, tolerability, and cost of iron polymaltose complex with ferrous sulfate in the treatment of iron deficiency anemia in pregnant women |journal=MedGenMed |volume=9 |issue=1 |pages=1 |year=2007 |pmid=17435611 |doi=}}</ref> or iron bis-glycinate chelate.<ref name="pmid11688081">{{cite journal |author=Szarfarc SC, de Cassana LM, Fujimori E, Guerra-Shinohara EM, de Oliveira IM |title=Relative effectiveness of iron bis-glycinate chelate (Ferrochel) and ferrous sulfate in the control of iron deficiency in pregnant women |journal=Arch Latinoam Nutr |volume=51 |issue=1 Suppl 1 |pages=42–7 |year=2001 |pmid=11688081 |doi=}}</ref><ref name="pmid11688084">{{cite journal |author=Ashmead SD |title=The chemistry of ferrous bis-glycinate chelate |journal=Arch Latinoam Nutr |volume=51 |issue=1 Suppl 1 |pages=7–12 |year=2001 |pmid=11688084 |doi=}}</ref> ==Contraindications== Documented [[hypersensitivity]] and anemias without proper work-up (i.e. documentation of iron deficiency). Hypersensitivity reactions can be very dramatic if iron is administered intravenously. ==Interactions== Iron forms an insoluble complex with several other drugs, resulting in decreased absorption of both iron and the other drug. Examples include [[tetracycline]], [[penicillamine]], [[methyldopa]], [[levodopa]], [[bisphosphonates]] and [[quinolones]]. The same can occur with elements in food, such as [[calcium]]. Absorption of iron is better at a low pH (an acid environment), and resorption is decreased if there is a simultaneous intake of antacids, phosphates, etc. Taken after a meal, there are fewer side effects but there is also less absorption because of interaction and pH alteration. Generally, an interval of 2-3h between the iron intake and that of other drugs seems advisable. ==Precautions== Children who ingest tablets may become intoxicated, in which case they should be taken to an emergency department. Some formulations (like carbonyl-iron) may be safer. ==Follow-up== Follow-up is needed to ensure compliance and to detect adequate response to therapy. If not, this may indicate another cause of anemia. [[Haematocrit]], [[reticulocyte]] percentage, [[Mean corpuscular volume|MCV]], [[MCH]] and [[MCHC]] (the latter three being signs of [[microcytic anemia]]) should increase. ==References== {{reflist}} ==See also== * [[Human iron metabolism]] {{Dietary supplement}} [[Category:Dietary supplements]] [[Category:hematology]]