Polysaccharide-Iron Complex and Folic Acid
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- Folic Acid and Polysaccharide-Iron Complex
- Iron-Polysaccharide Complex and Folic Acid
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product.
Powder for solution, oral:
NovaFerrum®: Elemental iron 100 mg and folic acid 1 mg per 5 mL (120 mL [DSC]) [contains ascorbic acid 60 mg/5 mL; raspberry-grape flavor]
Brand Names: U.S.
- NovaFerrum [DSC]
- Iron Salt
Use: Labeled Indications
Prevention and treatment of iron-deficiency anemias
Hypersensitivity to iron salts or any component of the formulation; hemosiderosis, hemochromatosis, or hemolytic anemias
Iron deficiency (prevention/treatment): Oral: 5 mL daily
Refer to adult dosing.
Children >12 years: Refer to adult dosing.
Dosing: Renal Impairment
No dosage adjustment provided in manufacturer’s labeling.
Dosing: Hepatic Impairment
No dosage adjustment provided in manufacturer’s labeling.
Reconstitute powder with 120 mL purified water. Shake well to dissolve.
Dietary sources of iron include beans, cereal (enriched), clams, beef, lentils, liver, oysters, shrimp, and turkey. Foods that enhance dietary absorption of iron include broccoli, grapefruit, orange juice, peppers and strawberries. Foods that decrease dietary absorption of iron include coffee, dairy products, soy products, spinach, and tea.
Prior to reconstitution, store at 15°C to 30°C (59°F to 86°F). Refrigerate after mixing. Discard any remaining solution after 30 days.
Alpha-Lipoic Acid: Iron Salts may decrease the absorption of Alpha-Lipoic Acid. Alpha-Lipoic Acid may decrease the absorption of Iron Salts. Consider therapy modification
Antacids: May decrease the absorption of Iron Salts. Consider therapy modification
Bisphosphonate Derivatives: Iron Salts may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral iron supplements within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Exceptions: Pamidronate; Zoledronic Acid. Consider therapy modification
Cefdinir: Iron Salts may decrease the serum concentration of Cefdinir. Red-appearing, non-bloody stools may also develop due to the formation of an insoluble iron-cefdinir complex. Management: Avoid concurrent cefdinir and oral iron when possible. Separating doses by several hours may minimize interaction. Iron-containing infant formulas do not appear to interact with cefdinir. Consider therapy modification
Deferiprone: Iron Salts may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Consider therapy modification
Dimercaprol: May enhance the nephrotoxic effect of Iron Salts. Avoid combination
Dolutegravir: Iron Salts may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral iron. Alternatively, dolutegravir and oral iron can be taken together with food. Consider therapy modification
Eltrombopag: Iron Salts may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any iron-containing product. Consider therapy modification
Entacapone: Iron Salts may decrease the serum concentration of Entacapone. Management: Consider separating doses of the agents by 2 or more hours to minimize the effects of this interaction. Monitor for decreased therapeutic effects of levodopa during concomitant therapy, particularly if doses cannot be separated. Consider therapy modification
Ferric Hydroxide Polymaltose Complex: May decrease the serum concentration of Iron Salts. Specifically, the absorption of oral iron salts may be reduced. Management: Do not administer intravenous (IV) ferric hydroxide polymaltose complex with other oral iron salts. Therapy with oral iron salts should begin 1 week after the last dose of IV ferric hydroxide polymaltose complex. Consider therapy modification
Fosphenytoin: Folic Acid may decrease the serum concentration of Fosphenytoin. Monitor therapy
Green Tea: May decrease the serum concentration of Folic Acid. Monitor therapy
H2-Antagonists: May decrease the absorption of Iron Salts. Monitor therapy
Levodopa: Iron Salts may decrease the serum concentration of Levodopa. Only applies to oral iron preparations. Management: Consider separating doses of the agents by 2 or more hours to minimize the effects of this interaction. Monitor for decreased therapeutic effects of levodopa during concomitant therapy, particularly if doses cannot be separated. Consider therapy modification
Levothyroxine: Iron Salts may decrease the serum concentration of Levothyroxine. Management: Separate oral administration of iron salts and levothyroxine by at least 4 hours. Separation of doses is not required with parenterally administered iron salts or levothyroxine. Consider therapy modification
Methyldopa: Iron Salts may decrease the serum concentration of Methyldopa. Consider therapy modification
PenicillAMINE: Iron Salts may decrease the absorption of PenicillAMINE. Only oral iron salts are a concern. Consider therapy modification
PHENobarbital: Folic Acid may decrease the serum concentration of PHENobarbital. Monitor therapy
Phenytoin: Folic Acid may decrease the serum concentration of Phenytoin. Monitor therapy
Phosphate Supplements: Iron Salts may decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate and iron administration. Administer oral phosphate supplements at least 1 hour before, or 2 hours after, oral iron salt administration. Exceptions: Sodium Glycerophosphate Pentahydrate. Consider therapy modification
Primidone: Folic Acid may decrease the serum concentration of Primidone. Additionally, folic acid may decrease concentrations of active metabolites of primidone (e.g., phenobarbital). Monitor therapy
Proton Pump Inhibitors: May decrease the absorption of Iron Salts. Monitor therapy
Quinolone Antibiotics: Iron Salts may decrease the serum concentration of Quinolone Antibiotics. Management: Administer oral quinolones at least several hours before (4 h for moxi- and sparfloxacin, 2 h for others) or after (8 h for moxi-, 6 h for cipro-, 4 h for lome-, 3 h for gemi-, and 2 h for levo-, nor-, or ofloxacin or nalidixic acid) oral iron salts. Exceptions: LevoFLOXacin (Oral Inhalation). Consider therapy modification
Raltitrexed: Folic Acid may diminish the therapeutic effect of Raltitrexed. Avoid combination
SulfaSALAzine: May decrease the serum concentration of Folic Acid. Monitor therapy
Tetracycline Derivatives: May decrease the absorption of Iron Salts. Iron Salts may decrease the serum concentration of Tetracycline Derivatives. Consider therapy modification
Trientine: May decrease the serum concentration of Iron Salts. Iron Salts may decrease the serum concentration of Trientine. Management: Trientine manufacturer recommends avoiding concurrent use with oral iron salts due to the risk for impaired GI absorption of both trientine and the iron salt. Short courses of iron may be used; however, separate administration by at least 2 hours. Consider therapy modification
Frequency not defined.
Gastrointestinal: Abdominal pain, constipation, darkening of stools, diarrhea, nausea, vomiting
Hypersensitivity: Hypersensitivity reaction
• Anemia: Not appropriate for use with pernicious, aplastic, or normocytic anemias when anemia is present with vitamin B12 deficiency.
• Pernicious anemia: Folate doses >0.1 mg/day may obscure pernicious anemia in that hematologic remission can occur with continuing irreversible nerve damage progression.
• Pediatric: Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6 years of age. Keep this product out of the reach of children. In case of accidental overdose call the poison control center immediately.
It is recommended that pregnant women meet the dietary requirements of iron with diet and/or supplements in order to prevent adverse events associated with iron-deficiency anemia in pregnancy. Treatment of iron-deficiency anemia in pregnant women is the same as in nonpregnant women, and in most cases, oral iron preparations may be used. Except in severe cases of maternal anemia, the fetus achieves normal iron stores regardless of maternal concentrations.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience constipation, diarrhea, or stool discoloration. Have patient report immediately to prescriber black, tarry, or bloody stools; severe nausea; severe vomiting; severe abdominal pain; vomiting blood; or abdominal cramps (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
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- Drug class: iron products