Pronunciation:

(FER us FYOO ma rate)

U.S. Brand Names:

Synonyms:

Generic Available:

Canadian Brand Names:

Use:

Pregnancy Risk Factor:

Contraindications:

Warnings/Precautions:

Adverse Reactions:

>10%: Gastrointestinal: Stomach cramping, constipation, nausea, vomiting, dark stools

1% to 10%:

Gastrointestinal: Heartburn, diarrhea, staining of teeth

Genitourinary: Discoloration of urine

<1%: Contact irritation

Overdosage/Toxicology:

Symptoms of overdose include acute GI irritation, erosion of GI mucosa, hepatic and renal impairment, coma, hematemesis, lethargy, acidosis, serum Fe level >300 mcg/mL requires treatment of overdose due to severe toxicity

Following treatment for fluid losses, metabolic acidosis, and shock, a severe iron overdose may be treated with deferoxamine. Deferoxamine may be administered I.V. (80 mg/kg over 24 hours) or I.M. (40-90 mg/kg every 8 hours). Usual toxic dose of elemental iron: 35 mg/kg.

Drug Interactions:

Antacids and H2 blockers (cimetidine): Concurrent administration may decrease iron absorption.

Chloramphenicol: Response to iron therapy may be delayed.

Levodopa, methyldopa, penicillamine: Iron may decrease absorption when given at the same time.

Quinolones: Absorption may be decreased due to formation of a ferric ion-quinolone complex

Tetracyclines: Absorption of oral preparation of iron and tetracyclines are decreased when both of these drugs are given together

Vitamin C: Concurrent administration of 200 mg vitamin C per 30 mg elemental iron increases absorption of oral iron.

Ethanol/Nutrition/Herb Interactions:

Mechanism of Action:

Pharmacodynamics/Kinetics:

Onset of action: Hematologic response: Oral, parenteral iron salts: ~3-10 days

Peak effect: Reticulocytosis: 5-10 days; hemoglobin values increase within 2-4 weeks

Absorption: Iron is absorbed in the duodenum and upper jejunum; in persons with normal serum iron stores, 10% of an oral dose is absorbed, this is increased to 20% to 30% in persons with inadequate iron stores. Food and achlorhydria will decrease absorption.

Protein binding: To serum transferrin

Excretion: Urine, sweat, sloughing of intestinal mucosa, and menses

Dosage:

Children:

Severe iron-deficiency anemia: 4-6 mg Fe/kg/day in 3 divided doses

Mild to moderate iron deficiency anemia: 3 mg Fe/kg/day in 1-2 divided doses

Prophylaxis: 1-2 mg Fe/kg/day

Adults:

Iron deficiency: 60-100 mg twice daily up to 60 mg 2 times/day

Prophylaxis: 60-100 mg/day

To avoid GI upset, start with a single daily dose and increase by 1 tablet/day each week or as tolerated until desired daily dose is achieved

Elderly: 200 mg 3-4 times/day

Administration:

Reference Range:

Serum iron:

Male: 75-175 mcg/dL (SI: 13.4-31.3 mol/L)

Female: 65-165 mcg/dL (SI: 11.6-29.5 mol/L)

Total iron binding capacity: 230-430 mcg/dL

Transferrin: 204-360 mg/dL

Percent transferrin saturation: 20% to 50%

Iron levels >300 mcg/dL can be considered toxic, should be treated as an overdose

Dietary Considerations:

Elemental iron content of ferrous fumarate: 33%

Patient Education:

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Dosage Forms:

Tablet: 324 mg [elemental iron 106 mg]

Femiron®: 63 mg [elemental iron 20 mg]

Ferretts: 325 mg [elemental iron 106 mg]

Hemocyte®: 324 mg [elemental iron 106 mg]

Ircon®: 200 mg [elemental iron 66 mg]

Nephro-Fer®: 350 mg [elemental iron 115 mg; contains tartrazine]

Tablet, chewable (Feostat®): 100 mg [elemental iron 33 mg; chocolate flavor]

Tablet, timed release (Ferro-Sequels®): 150 mg [elemental iron 50 mg; contains docusate sodium and sodium benzoate]

International Brand Names: