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- Iron-Polysaccharide Complex
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
EZFE 200: 200 mg [non-toxic; contains brilliant blue fcf (fd&c blue #1), fd&c red #40, fd&c yellow #10 (quinoline yellow)]
Ferrex 150: 150 mg [contains fd&c blue #1 aluminum lake, fd&c red #40 aluminum lake, fd&c yellow #5 aluminum lake]
Ferric x-150: 150 mg [contains brilliant blue fcf (fd&c blue #1), fd&c red #40, tartrazine (fd&c yellow #5)]
iFerex 150: 150 mg [DSC] [contains brilliant blue fcf (fd&c blue #1), fd&c red #40, fd&c yellow #10 (quinoline yellow)]
Myferon 150: 150 mg
NovaFerrum 50: 50 mg
Nu-Iron: 150 mg [contains brilliant blue fcf (fd&c blue #1), fd&c red #40]
PIC 200: 200 mg [DSC]
Poly-Iron 150: 150 mg
NovaFerrum 125: Polysaccharide-iron complex 125 mg and cholecalciferol 100 units per 5 mL (180 mL) [alcohol free, dye free, gluten free, lactose free, sodium free, sugar free; contains sodium benzoate; raspberry-grape flavor]
NovaFerrum Pediatric Drops: 15 mg/mL (120 mL) [alcohol free, dye free, gluten free, lactose free, sodium free, sugar free; contains sodium benzoate; raspberry-grape flavor]
Brand Names: U.S.
- EZFE 200 [OTC]
- Ferrex 150 [OTC]
- Ferric x-150 [OTC]
- iFerex 150 [OTC] [DSC]
- Myferon 150 [OTC]
- NovaFerrum 125 [OTC]
- NovaFerrum 50 [OTC]
- NovaFerrum Pediatric Drops [OTC]
- Nu-Iron [OTC]
- PIC 200 [OTC] [DSC]
- Poly-Iron 150 [OTC]
- Iron Salt
Oral: Iron is absorbed in the duodenum and upper jejunum; in persons with normal 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
Urine, sweat, sloughing of intestinal mucosa, and by menses
Onset of Action
Hematologic response: Red blood cells form within 3 to 10 days; similar onset as parenteral iron salts; Maximum effect: Peak reticulocytosis occurs in 5 to 10 days, and hemoglobin values increase within 2 to 4 weeks
Use: Labeled Indications
Iron deficiency anemia: Management (prevention and treatment) of iron deficiency anemia
Known hypersensitivity to polysaccharide-iron complex or any component of the formulations; hemochromatosis; hemosiderosis
Documentation of allergenic cross-reactivity for other iron-containing products is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.
Note: Immediate release oral iron products are preferred for treatment of iron deficiency anemia; enteric coated and slow/sustained release preparations are not desired due to poor absorption (Hershko 2014; Liu 2012).
Iron deficiency anemia: Oral: 150 to 300 mg daily
Refer to adult dosing.
Iron deficiency anemia: Oral:
Infants and Children <4 years: 15 mg daily
Children ≥12 years: 50 mg daily
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.
Dietary reference intake (elemental iron) (IOM 2001):
0 to 6 months: Adequate intake: 0.27 mg daily
7 to 12 months: RDA: 11 mg daily
1 to 3 years: RDA: 7 mg daily
4 to 8 years: RDA: 10 mg daily
9 to 13 years: RDA: 8 mg daily
14 to 18 years: RDA:
Males: 11 mg daily
Females: 15 mg daily
Pregnancy: 27 mg daily
Lactation: 10 mg daily
19-50 years: RDA:
Males: 8 mg daily
Females: 18 mg daily
Pregnancy: 27 mg daily
Lactation: 9 mg daily
≥50 years: RDA: 8 mg daily
Store between 15°C and 30°C (59°F and 86°F).
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
Baloxavir Marboxil: Iron Salts may decrease the serum concentration of Baloxavir Marboxil. Avoid combination
Bictegravir: Iron Salts may decrease the serum concentration of Bictegravir. Management: Bictegravir, emtricitabine, and tenofovir alafenamide can be administered with iron salts under fed conditions, but coadministration with or 2 hours after an iron salt is not recommended under fasting conditions. 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. Administer dolutegravir/rilpivirine at least 4 hours before or 6 hours after oral iron salts. 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
Histamine H2 Receptor Antagonists: May decrease the absorption of Iron Salts. Monitor therapy
Iron Isomaltoside: May decrease the serum concentration of Iron Salts. Specifically, absorption of oral iron salts may be reduced. Management: Do not administer intravenous (IV) iron isomaltoside with other oral iron salts. Therapy with oral iron salts should begin 5 days after the last dose of IV iron isomaltoside. Consider therapy modification
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. Management: Separate the administration of penicillamine and oral iron salts by at least 1 hour. Consider therapy modification
Phosphate Supplements: Iron Salts may decrease the absorption of Phosphate Supplements. Management: Administer oral phosphate supplements as far apart from the administration of an oral iron salt as possible to minimize the significance of this interaction. Exceptions: Sodium Glycerophosphate Pentahydrate. Consider therapy modification
Proton Pump Inhibitors: May decrease the absorption of Iron Salts. Monitor therapy
Quinolones: Iron Salts may decrease the serum concentration of Quinolones. Management: Give 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/dela-, 4 h for lome-, 3 h for gemi-, and 2 h for levo-, nor-, oflox-, pefloxacin, or nalidixic acid) oral iron salts Exceptions: LevoFLOXacin (Oral Inhalation). Consider therapy modification
Tetracyclines: May decrease the absorption of Iron Salts. Iron Salts may decrease the serum concentration of Tetracyclines. Exceptions: Eravacycline. 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
>10%: Gastrointestinal: Constipation, darkening of stools, epigastric pain, gastrointestinal irritation, nausea, stomach cramps, vomiting
1% to 10%:
Gastrointestinal: Dental discoloration, diarrhea, heartburn
Genitourinary: Urine discoloration
<1%, postmarketing, and/or case reports: Local irritation
Concerns related to adverse effects:
• Stool discoloration: Oral iron preparations commonly cause dark or black stools; patients should be informed of the effect.
Concurrent drug therapy issues:
• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. May interfere with absorption of antibiotics.
• 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.
Dosage form specific issues:
• Oral iron formulations: Immediate release oral iron products are preferred for treatment of iron deficiency anemia; enteric coated and slow/sustained release preparations are not desired due to poor absorption (Hershko 2014; Liu 2012).
• Appropriate use: Investigate type of anemia and potential underlying causes (eg, recurrent blood loss) prior to initiating iron supplementation.
• Excipient: Some formulations may contain tartrazine, which is associated with allergic-type reactions. Although rare, hypersensitivity is more frequently seen in individuals with aspirin allergy.
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, stool discoloration, or diarrhea. 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.
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